Coronary artery bypass surgery in octogenarians: long-term outcome can be better than expected

Abstract

Background: We have reviewed our experience with octogenarians undergoing coronary artery bypass grafting.

Methods: A consecutive series of 274 patients age 80 years or greater out of 3,474 patients who underwent isolated coronary artery bypass grafting. We have assessed the intrinsic risk aged 80 years or greater by comparing them with a propensity score-matched cohort of younger patients with similar operative risk (other than age).

Results: Thirty-day mortality (4.7% vs 1.3%, p<0.0001), combined adverse event rates (13.1% vs 6.6%, p<0.0001), and five-year survival (76.6% vs 90.4%, p<0.0001) were significantly poorer among patients aged 80 years or greater as compared with younger patients. These figures were, however, better than estimates of a recent systematic review by McKellar and colleagues (McKellar SH, Brown ML, Frye RL, Schaff HV, Sundt TM III. Comparison of coronary revascularization procedures in octogenarians: a systematic review and meta-analysis. Nat Clin Pract Cardiovasc Med 2008;5:738-46) (30-day mortality 7.2%, and five-year survival, 68%). When octogenarians were compared with 273 propensity score-matched patients aged less than 80 years, the 30-day mortality (4.8% vs 2.6%, p=0.17) and combined adverse event rates (13.2% vs 10.6%, p=0.36) did not significantly differ. Five-year survival, despite statistical significance, was not remarkably lower than that of propensity-matched patients aged less than 80 years (77.0% vs 81.3%, p=0.009). The decrease in survival of octogenarians was evident only during the first few months after surgery, but not later on.

Conclusions: The results of this study suggest that immediate and five-year survival of octogenarians undergoing coronary artery bypass grafting may be even better than previously estimated. Survival of octogenarians may be suboptimal only during the first few months after surgery, whereas at five years may not differ remarkably from younger patients with otherwise similar operative risk.