Outcomes of Coronary Artery Bypass Graft Surgery in Octogenarians: Results From the Australian Cardiac Surgery...

We aimed to evaluate the risks and outcomes of coronary artery bypass grafting in patients aged ≥80 years in Australia.

We conducted a retrospective cohort study of 96,849 patients who underwent isolated coronary artery bypass surgery between 1 January 2001 and 31 December 2022, using data from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons cardiac surgery database. Patients were stratified into octogenarians and non-octogenarians. Primary outcomes included operative mortality (30-day or in-hospital death) and long-term survival. Kaplan-Meier estimates were used to analyse survival, logistic regression to identify predictors of early mortality, and Cox proportional hazards to identify predictors of late mortality. Survival in the octogenarian cohort was compared with an age- and sex-matched Australian population.

Operative mortality was 2.8% in octogenarians vs 1.0% in non-octogenarians. The median follow-up was 3.4 years, with Kaplan-Meier estimated survival rates of 93%, 72%, 37% and 14% at 1, 5, 10, and 15 years. Median survival was 8.0 years in octogenarians, compared to 6.7 years in an age- and sex-matched general Australian population. The standardised mortality ratio was 0.78 (95% confidence interval 0.75-0.82; p<0.001).

Although octogenarians undergoing coronary artery bypass have a higher operative risk than younger patients, mortality rates are lower than previously reported. Surgery in this population may be associated with favourable long-term survival compared to the general population. These findings support careful patient selection and shared decision-making when considering surgical revascularisation in the elderly.