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Coronary revascularization in the elderly patient.

M A Elayda, R J Hall, A G Gray

    Journal of the American College of Cardiology
    |June 1, 1984
    PubMed
    Summary

    Coronary artery bypass surgery is a successful alternative for elderly patients with severe angina when medical management fails. Improved surgical techniques have significantly reduced operative mortality rates in this high-risk group.

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    Area of Science:

    • Cardiology
    • Geriatric Medicine
    • Cardiovascular Surgery

    Background:

    • Elderly patients (≥70 years) with severe angina are considered high-risk surgical candidates.
    • Coronary artery bypass (CAB) surgery alone was performed on 1,275 elderly patients between 1970 and 1981.
    • The proportion of elderly patients undergoing CAB surgery increased significantly from 2.04% in 1971 to 8.2% in 1981.

    Purpose of the Study:

    • To evaluate the efficacy and safety of coronary artery bypass surgery in elderly patients.
    • To assess the changes in operative mortality and long-term outcomes over time.
    • To determine if CAB surgery is a viable option for elderly patients with severe angina unresponsive to medical therapy.

    Main Methods:

    • Retrospective analysis of 1,275 elderly patients (≥70 years) who underwent isolated coronary artery bypass surgery from 1970 to 1981.

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  • Comparison of early mortality rates between two distinct periods: 1970-1975 (n=158) and 1976-1981 (n=1,117).
  • Assessment of long-term survival rates and symptom relief at follow-up.

    • Main Results:

    • Overall early mortality was 5.8%, with a significant decrease from 13.9% (1970-1975) to 4.7% (1976-1981).
    • Angina symptoms were relieved or decreased in 89% of patients post-surgery.
    • Five-year survival was 80.6%, and ten-year survival was 44.1%.

    Conclusions:

    • Coronary artery bypass surgery is a successful alternative for elderly patients with severe angina when medical management fails.
    • Advancements in surgical techniques and myocardial preservation have progressively reduced operative risks.
    • Elderly patients, despite being high-risk, can achieve significant symptom relief and survival benefits from CAB surgery.