Current status of coronary artery operation in septuagenarians

Abstract

Previous reports of elderly patients undergoing coronary artery bypass grafting have not addressed the current era of aggressive percutaneous angioplasty and frequent urgent or emergent operation. To investigate this important subgroup of patients, we analyzed our recent coronary artery bypass grafting experience with patients 70 years of age or older. From January 1984 to January 1989, 121 consecutive patients in this age range underwent surgical revascularization at our institution. Overall inhospital operative mortality (OM) was 7.4% ( 9 / 121 ), with 77.8% ( 7 / 9 ) of deaths due to cardiac causes. Serious postoperative morbidity occurred in 71.1% ( 86 / 121 ). Surgical priority was significantly correlated with operative mortality: for elective cases, the OM was 2.9% ( 2 / 68 ), but it was 8.6% ( 3 / 35 ) for urgent cases ( p < 0.05) and 22.2% ( 4 / 18 ) for emergency cases ( p < 0.05). Univariate analysis isolated the need for inotropic support, intraaortic balloon pump, reoperation, cardiopulmonary resuscitation, and emergency status as significant risk factors for OM ( p < 0.05). Multivariate stepwise logistic regression analysis identified the need for inotropic support, intravenous nitroglycerin, reoperative coronary artery bypass grafting, and hypertension as independently significant risk factors. A logistic risk equation developed from this population accurately modeled OM at the extremes of operative risk. Three (3.1%) of the 97 patients predicted to have less than 5% OM died, whereas all patients predicted by the model to have greater than 90% OM died. These results indicate that in spite of relatively high morbidity and mortality rates, elderly patients have a very acceptable operative risk in the current era of high-risk coronary artery bypass grafting. This is particularly true if elective revascularization is possible.