Efficacy of coronary artery bypass grafting in elderly patients with coronary artery disease

Abstract

A consecutive series of 121 patients 70 years of age and older who underwent aortocoronary artery saphenous vein bypass grafting without other cardiac procedures during a 5 year period was analyzed and follow-up status ascertained. This group was compared with a consecutive series of 2,850 patients under the age of 70 who underwent aortocoronary bypass during the same period. The patients aged 70 years or greater had a higher incidence of unstable angina pectoris, congestive heart fallure and cardlomegaly on roentgenography. They had more severe coronary obstruction with a 29 percent incidence rate of left main coronary disease versus a 15 percent incidence rate in the patients aged less than 70 years (P < 0.001). The hospital mortality rate for patients aged less than 70 years was 1.1 percent (31 of 2,850) and for those aged 70 years or greater was 1.6 percent (2 of 121). The 119 patients aged 70 years or greater who survived surgery had a significantly greater incidence of postoperative stroke (3 patients), supraventricular tachycardia (28 patients), transient postoperative psychosis (9 patients), heart block requiring permanent pacing (2 patients), intraaortic balloon pumping (5 patients) and pulmonary embolism (4 patients) than patients aged less than 70 years. Both groups had significant symptomatic improvement: More than 95 percent of the survivors in each group were angina-free or in improved condition at late follow-up. Survival at 36 months was 95 percent for the patients in both age groups. A subgroup of patients aged 75 years or greater had comparable symptomatic results and survival. Patients aged 70 years or greater need not be denied the benefits of coronary bypass surgery on the basis of advanced age alone, although these patients have complfcations of surgery more frequently. However, severe calcification of the ascending aorta is a relative contraindication to saphenous vein bypass surgery in this age group.