A retrospective study from Kubkin Choi and researchers from Mayo Clinic (Rochester, USA) has found that coronary artery bypass grafting (CABG) in patients over the age of 80 was associated with favourable outcomes and increased long-term survival, despite carrying a high surgical risk.
Further research is needed to identify patient groups that may benefit most from surgical revascularisation, according to Choi and co-authors of the study published in Mayo Clinic Proceedings.
Researchers reviewed case histories for 1,283 patients who were older than age 80 and underwent primary isolated CABG at Mayo Clinic in Rochester between 1 January 1993 and 31 October 2019. Median survival time was 7.6 years, compared with six years for age- and sex-matched octogenarians in the general US population.
“Our results show that coronary artery bypass surgery can be beneficial for patients over age 80,” says Choi, a clinical fellow in cardiac surgery and the study’s first author. “The key is to carefully identify patients who can most benefit from the procedure. That is what future research can help with: to identify subgroups of patients who can most benefit.”
The patients’ survival rate was 90.2% at one year, 67.9% at five years, 31.1% at 10 years and 8.2% at 15 years, according to the study. The surgical mortality rate was 4%, but it declined significantly during the 26-year study period. Mortality in the last three years of the study period was 1.6%. Risk factors associated with reduced survival time included advanced age, diabetes mellitus, smoking history and chronic lung disease.
Just over 56% of the surgeries were elective procedures, 40% were performed in urgent situations and 3.8% were emergencies.
“The longer median survival in octogenarians undergoing surgery and the relatively low rates of complications observed in our study imply that with tailored surgery candidacy and consideration of specific high-risk factors, CABG may be an important treatment strategy for those patients with multivessel coronary artery disease,” says Choi.