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Coronary revascularization in septuagenarians
Insights
Coronary artery bypass surgery shows increased risk in elderly patients, particularly women over 70. Careful patient selection is crucial for this cardiac procedure.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Coronary artery bypass grafting (CABG) has a long history, but optimal indications, especially for elderly patients, remain debated.
- Patient demographics and outcomes for CABG have evolved, necessitating updated risk assessments.
Purpose of the Study:
- To evaluate the operative mortality and risk factors associated with coronary artery revascularization in different age and sex groups.
- To analyze outcomes in patients over 70 undergoing CABG, identifying specific risk factors for mortality.
Main Methods:
- Retrospective analysis of 2,667 patients undergoing coronary artery revascularization between 1974 and 1980.
- Stratification of patients by age (<70 and ≥70 years) and sex.
- Analysis of risk factors including smoking, diabetes, and pulmonary artery pressures.
Main Results:
- Overall mortality was 3.8%, decreasing to 1% in the last year of the study.
- Patients ≥70 years had significantly higher mortality (10.5%) compared to those <70 years (3.5%).
- Women experienced higher mortality than men, especially in the ≥70 age group (28.6% vs. 6%).
Conclusions:
- Coronary artery revascularization is feasible in men <70 with acceptable risk.
- Elderly patients (≥70) face a twofold increase in mortality risk, requiring careful selection.
- Women, particularly those ≥70, have a significantly higher operative risk and necessitate stringent selection criteria for CABG.
Abstract:
Despite a 15 year experience with the aorta-coronary bypass operation, indications for its use remain unsettled, especially in the elderly. Between January, 1974, and June, 1980, 2,667 patients underwent coronary artery revascularization with an overall mortality of 3.8% (101/2,667). During the last 12 months the mortality has decreased to 1%. There were 2,562 patients below the age of 70, with a mortality of 3.5% (90/2,562), in contrast to 105 patients over the age of 70, with a mortality of 10.5% (11/105) (p = 0.002). In patients less than 70 years of age there was a significant difference between the mortality of men, 3.12% (67/2,146), and that of women, 5.53% (23/416) (p = 0.015). This disparity of operative risk was far more pronounced in patients over 70 years of age: men 6% (5/84) and women 28.6% (6/21) (p = 0.002). The overall operative mortality of women, 6.6% (29/437), was significantly different from the overall mortality of men, 3.2% (72/2,230) (p = 0.001). An in depth analysis of past medical history, risk factors, and catheterization data is presented in those patients over the age of 70. The average number of vessels bypassed was 2.40: men 2.47 and women 2.09 (p = NS). The ages varied from 70 to 81 years with a mean of 72.5. Smoking (p = 0.012) and diabetes (p = 0.0078) were significant risk factors for coronary disease. Smoking (p = 0.032) and abnormal pulmonary artery pressures (p = 0.0429) were significant variables affecting mortality. A 97.1% follow-up was obtained up to 78 months. Coronary artery revascularization can be performed in men below the age of 70 with acceptable mortality, but there is a twofold increase above the age of 70. Women can undergo revascularization below the age of 70 with a significantly higher risk than males. Those above the age of 70 are at severe risk and should undergo revascularization only after careful selection.