The influence of age on the outcome of primary coronary artery bypass grafting

Background. With the steady increase in the number of elderly patients requiring coronary artery bypass grafting (CABG), scepticism still exists as to whether this operationi is justified in older patients or not, and whether there is an upper age limit. The aim of this study was to examine the effects of increasing age on the outcome of CABG. Methods. A retrospective review was performed on 2127 consecutive patients undergoing primary CABG from January 1990 through June 1996. The patients were arbitrarily divided into age groups: 69 years or less (n = 1607), 70-75 years (n = 371), 76-80 years (n = 129) and older than 80 years (n = 20). Mortality, morbidity and long-term survival for each group was compared. Results. The groups containing the elderly patients showed an over-representation of women, as well as a higher frequency of arterial hypertension, hyperlipidemia, previous infarction and diabetes. More patients, amongst the elderly, had unstable angina and diffuse coronary disease requiring urgent surgery and coronary thrombendarterectomy compared to those <70 years. Hospital mortality did not differ between the groups, 1.8, 3.0, 2.3 and 5.0%. There was an increased incidence of low postoperative cardiac output and a higher incidence of gastro-intestinal complications amongst the elderly. The 5-year survival was 92.2% (<70 years), 87.0% (70-75 years) and 86.3% (76-80 years) and the cardiac event-free survival was 87.5% (<70 years), 78.4% (70-75 years) and 80.8% (76-80 years) at 5 years. Conclusions. An acceptable early mortality and medium-term survival(5 years) together with excellent functional medium-term results support the justification of primary CABG in older patients Irrespective of age.