ISOLATED CORONARY-ARTERY BYPASS-GRAFTING IN PATIENTS 70 YEARS OF AGE AND OLDER - EARLY AND LATE RESULTS

Abstract

Increasing longevity makes the consideration of coronary bypass common in elderly patients. Patients (n = 75; over 70 yr old) undergoing coronary artery bypass grafting (CABG) for angina pectoris were compared to a control group of 75 patients < 70 yr of age. The groups were matched for male:female ratio (46:29), previous infarction (28/75), unstable angina (27/75) and the requirement for preoperative intra-aortic balloon pumping (7/75). Patients < 70 yr of age had an average preoperative New York Heart Association (NYHA) class of 3.0 .+-. 0.6 (SEM) [standard error of the mean] and an average left ventricular end-diastolic pressure of 15.5 .+-. 0.8 mm Hg, compared to 3.3 .+-. 0.6 and 12.9 .+-. 1.1 mm Hg, respectively, for the older group. Average grafts per patient were 2.7 .+-. 0.8 in the younger group and 2.8 .+-. 0.1 in the older group. Overall operative mortality for patients < 70 yr was 4% (3/75) vs. 12% (9/75) (P = 0.06) for patients over 70. The incidence of chronic stable angina was 2% (1/48) vs. 6% (3/48) (P = 0.30). Perioperative infarctions occurred in 7% of those < 70 yr and 5% of those over 70 yr (P = 0.54). Those < 70 averaged 13.8 .+-. 0.6 postoperative hospital days vs. 18.4 .+-. 1.2 hospital days for the older group (P < 0.05). Follow-up ranged from 2-94 mo., averaging 22 mo. for patients < 70 and 24 mo. for those over 70 yr. Late cardiac mortality rates were 4% (3/70) in the younger patients and 3% (2/66) in the older patients (P = 0.53). Current NYHA class was 1.3 .+-. 0.7 for those < 70, with 9% reporting angina, and 1.4 .+-. 0.7 for those over 70 yr, with 6% reporting angina. CABG can be performed with acceptable risk in older patients and leads to encouraging symptomatic improvement and late survival.