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Coronary Artery Bypass Grafting in Octogenarians—Risks, Outcomes, and Trends in 1283 Consecutive Patients

      Abstract

      Objective

      To describe the risks, outcomes, and trends in patients older than 80 years undergoing coronary artery bypass grafting (CABG).

      Methods

      We retrospectively studied 1283 consecutive patients who were older than 80 years and underwent primary isolated CABG from January 1, 1993, to October 31, 2019, in our clinic. Kaplan-Meier survival probability and quartile estimates were used to analyze patients’ survival. Logistic regression models were used for analyzing temporal trends in CABG cases and outcomes. A multivariable Cox proportional hazards regression model was developed to study risk factors for mortality.

      Results

      Operative mortality was overall 4% (n=51) but showed a significant decrease during the study period (P=.015). Median follow-up was 16.7 (interquartile range, 10.3-21.1) years, and Kaplan-Meier estimated survival rates at 1 year, 5 years, 10 years, and 15 years were 90.2%, 67.9%, 31.1%, and 8.2%, respectively. Median survival time was 7.6 years compared with 6.0 years for age- and sex-matched octogenarians in the general US population (P<.001). Multivariable Cox regression analysis identified older age (P<.001), recent atrial fibrillation or flutter (P<.001), diabetes mellitus (P<.001), smoking history (P=.006), cerebrovascular disease (P=.04), immunosuppressive status (P=.01), extreme levels of creatinine (P<.001), chronic lung disease (P=.02), peripheral vascular disease (P=.02), decreased ejection fraction (P=.03) and increased Society of Thoracic Surgeons predicted risk score (P=.01) as significant risk factors of mortality.

      Conclusion

      Although CABG in octogenarians carries a higher surgical risk, it may be associated with favorable outcomes and increase in long-term survival. Further studies are warranted to define subgroups benefiting more from surgical revascularization.

      Abbreviations and Acronyms:

      BIMA (bilateral internal mammary artery), CABG (coronary artery bypass grafting), IQR (interquartile range), LAD (left anterior descending artery), LIMA (left internal mammary artery), MI (myocardial infarction), PCI (percutaneous coronary intervention), STS (Society of Thoracic Surgeons), SVG (saphenous vein graft), SWI (sternal wound infection)
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      References

        • Head S.J.
        • Holmes Jr., D.R.
        • Mack M.J.
        • et al.
        Risk profile and 3-year outcomes from the SYNTAX percutaneous coronary intervention and coronary artery bypass grafting nested registries.
        JACC Cardiovasc Interv. 2012; 5: 618-625
        • Matsumura-Nakano Y.
        • Shiomi H.
        • Morimoto T.
        • et al.
        Surgical ineligibility and long-term outcomes in patients with severe coronary artery disease.
        Circ J. 2019; 83: 2061-2069
        • McNulty E.J.
        • Ng W.
        • Spertus J.A.
        • et al.
        Surgical candidacy and selection biases in nonemergent left main stenting: implications for observational studies.
        JACC Cardiovasc Interv. 2011; 4: 1020-1027
        • Waldo S.W.
        • Secemsky E.A.
        • O'Brien C.
        • et al.
        Surgical ineligibility and mortality among patients with unprotected left main or multivessel coronary artery disease undergoing percutaneous coronary intervention.
        Circulation. 2014; 130: 2295-2301
        • Berezhnoi K.
        • Kokov L.
        • Vanyukov A.
        Effects of complete revascularization on long-term treatment outcomes in patients with multivessel coronary artery disease over 80 years of age admitted for acute coronary syndrome.
        Cardiovasc Diagn Ther. 2019; 9: 301-309
        • McKellar S.H.
        • Brown M.L.
        • Frye R.L.
        • Schaff H.V.
        • Sundt T.M.
        Comparison of coronary revascularization procedures in octogenarians: a systematic review and meta-analysis.
        Nat Clin Pract Cardiovasc Med. 2008; 5: 738-746
        • Kontis V.
        • Bennett J.E.
        • Mathers C.D.
        • Li G.
        • Foreman K.
        • Ezzati M.
        Future life expectancy in 35 industrialised countries: projections with a Bayesian model ensemble.
        Lancet. 2017; 389: 1323-1335
        • O'Brien S.M.
        • Feng L.
        • He X.
        • et al.
        The Society of Thoracic Surgeons 2018 adult cardiac surgery risk models: part 2—statistical methods and results.
        Ann Thorac Surg. 2018; 105: 1419-1428
        • The Society of Thoracic Surgeons
        STS Adult Cardiac Surgery Database Data Specifications, Version 4.20.2. Accessed February 23, 2022.
        • Bianco V.
        • Kilic A.
        • Gleason T.G.
        • et al.
        Midterm outcomes for isolated coronary artery bypass grafting in octogenarians.
        Ann Thorac Surg. 2020; 109: 1184-1193
        • Musa T.
        • Ogunbayo G.
        • Misumida N.
        • Abdel-Latif A.
        • Messerli A.
        Coronary artery bypass grafting in octogenarians: morbidity and mortality.
        J Am Coll Cardiol. 2018; 71: A197
        • Pevni D.
        • Ziv-Baran T.
        • Kramer A.
        • Farkash A.
        • Ben-Gal Y.
        Is the use of BITA vs SITA grafting safe and beneficial in octogenarians?.
        Ann Thorac Surg. 2021; 111: 1998-2003
        • Scott B.H.
        • Seifert F.C.
        • Grimson R.
        • Glass P.S.
        Octogenarians undergoing coronary artery bypass graft surgery: resource utilization, postoperative mortality, and morbidity.
        J Cardiothorac Vasc Anesth. 2005; 19: 583-588
        • Sen B.
        • Niemann B.
        • Roth P.
        • Aser R.
        • Schönburg M.
        • Böning A.
        Short- and long-term outcomes in octogenarians after coronary artery bypass surgery.
        Eur J Cardiothorac Surg. 2012; 42: e102-e107
        • Klein L.W.
        • Block P.
        • Brindis R.G.
        • et al.
        Percutaneous coronary interventions in octogenarians in the American College of Cardiology–National Cardiovascular Data Registry.
        J Am Coll Cardiol. 2002; 40: 394-402
        • Cockburn J.
        • Kemp T.
        • Ludman P.
        • et al.
        Percutaneous coronary intervention in octogenarians: a risk scoring system to predict 30-day outcomes in the elderly.
        Catheter Cardiovasc Interv. 2021; 98: 1300-1307
        • Bowdish M.E.
        • D’Agostino R.S.
        • Thourani V.H.
        • et al.
        STS Adult Cardiac Surgery Database: 2021 update on outcomes, quality, and research.
        Ann Thorac Surg. 2021; 111: 1770-1780
        • Alkhouli M.
        • Alqahtani F.
        • Kalra A.
        • et al.
        Trends in characteristics and outcomes of hospital inpatients undergoing coronary revascularization in the United States, 2003-2016.
        JAMA Netw Open. 2020; 3e1921326
        • Barywani S.B.
        • Li S.
        • Lindh M.
        • et al.
        Acute coronary syndrome in octogenarians: association between percutaneous coronary intervention and long-term mortality.
        Clin Interv Aging. 2015; 10: 1547-1553
        • Head S.J.
        • Milojevic M.
        • Daemen J.
        • et al.
        Mortality after coronary artery bypass grafting versus percutaneous coronary intervention with stenting for coronary artery disease: a pooled analysis of individual patient data.
        Lancet. 2018; 391 (Published correction appears in Lancet. 2018;392(10146):476): 939-948
        • Saran N.
        • Locker C.
        • Said S.M.
        • et al.
        Current trends in bilateral internal thoracic artery use for coronary revascularization: extending benefit to high-risk patients.
        J Thorac Cardiovasc Surg. 2018; 155: 2331-2343
        • Aldea G.S.
        • Bakaeen F.G.
        • Pal J.
        • et al.
        The Society of Thoracic Surgeons Clinical Practice Guidelines on Arterial Conduits for Coronary Artery Bypass Grafting.
        Ann Thorac Surg. 2016; 101: 801-809
        • Tatoulis J.
        • Buxton B.F.
        • Fuller J.A.
        Patencies of 2127 arterial to coronary conduits over 15 years.
        Ann Thorac Surg. 2004; 77: 93-101
        • Sabik 3rd, J.F.
        • Lytle B.W.
        • Blackstone E.H.
        • Houghtaling P.L.
        • Cosgrove D.M.
        Comparison of saphenous vein and internal thoracic artery graft patency by coronary system.
        Ann Thorac Surg. 2005; 79 ([discussion: 544-551]): 544-551
        • Leavitt B.J.
        • O'Connor G.T.
        • Olmstead E.M.
        • et al.
        Use of the internal mammary artery graft and in-hospital mortality and other adverse outcomes associated with coronary artery bypass surgery.
        Circulation. 2001; 103: 507-512
        • Ferguson Jr., T.B.
        • Coombs L.P.
        • Peterson E.D.
        Internal thoracic artery grafting in the elderly patient undergoing coronary artery bypass grafting: room for process improvement?.
        J Thorac Cardiovasc Surg. 2002; 123: 869-880
        • Zhang M.
        • Guddeti R.R.
        • Matsuzawa Y.
        • et al.
        Left internal mammary artery versus coronary stents: impact on downstream coronary stenoses and conduit patency.
        J Am Heart Assoc. 2016; 5e003568
        • Collins P.
        • Webb C.M.
        • Chong C.F.
        • Moat N.E.
        Radial artery versus saphenous vein patency randomized trial: five-year angiographic follow-up.
        Circulation. 2008; 117: 2859-2864
        • Taggart D.P.
        • Gavrilov Y.
        • Krasopoulos G.
        • et al.
        External stenting and disease progression in saphenous vein grafts two years after coronary artery bypass grafting: a multicenter randomized trial.
        J Thorac Cardiovasc Surg. 2021; (Published online April 21)https://doi.org/10.1016/j.jtcvs.2021.03.120
        • Williams D.B.
        • Carrillo R.G.
        • Traad E.A.
        • et al.
        Determinants of operative mortality in octogenarians undergoing coronary bypass.
        Ann Thorac Surg. 1995; 60: 1038-1043
        • Beebe-Dimmer J.L.
        • Pfeifer J.R.
        • Engle J.S.
        • Schottenfeld D.
        The epidemiology of chronic venous insufficiency and varicose veins.
        Ann Epidemiol. 2005; 15: 175-184
        • Deo S.V.
        • Shah I.K.
        • Dunlay S.M.
        • et al.
        Bilateral internal thoracic artery harvest and deep sternal wound infection in diabetic patients.
        Ann Thorac Surg. 2013; 95: 862-869