INFLUENCE OF INCREASING AGE ON LONG-TERM SURVIVAL AFTER CORONARY-ARTERY BYPASS-GRAFTING

Background. Despite the steady increase in the number of elderly patie nts undergoing coronary artery bypass grafting (CABG), skepticism stil l exists as to whether this operation is justified in older people wit h a reduced life expectancy. The purpose of this study was to examine the effects of increasing age on outcome after CABG. Methods. A retros pective chart review was performed on 1,689 consecutive veterans of th e United States Armed Forces undergoing isolated primary CABG from Jan uary 1972 through December 1994. For better comparison, they were arbi trarily divided by age into three groups: group I, 50 years of age or less (n = 213), group II, between 51 and 70 years of age (n = 1,258), and group III, more than 70 years of age (n = 218). Long-term survival for each group was compared to that of their age-matched population d erived from Wisconsin life tables. Results. The preoperative ejection fraction was comparable in all three groups (p = 0.114). The patients older than 70 years of age had received more grafts per operation than the patients 50 years of age and younger (3.7 versus 3.3) (p = 0.0001 ). Although the aortic cross-clamp time was prolonged with advanced ag e (p = 0.0002), the cardiopulmonary perfusion time was shortest in eld erly patients (p = 0.0001). The early (30-day) mortality for the entir e study population was 1.3%. There was a linear correlation between in creasing age and early (30-day) mortality: group I, 0.5% (1/213); grou p II, 1.0% (13/1,258); and group III, 3.2% (7/218). The overall 10-yea r actuarial survival for all patients was 67%. The 10-year survival wa s diminished with increasing age (p = 0.0001): 74% for group I, 68% fo r group II, and 47% for group III. Comparative analysis of the three g roups with their age-matched counterparts demonstrated an age-related survival after CABG. In group I, reduced survival was evident 4 years after the CABG: the 10-year survival in group I was 74.2%, and the sur vival of their age-matched population was 93.4% (confidence interval, 67% to 81.9%). In group II a survival difference was obvious 8 years a fter CABG: 10-year survival of 67.5% versus 75.1% in their age-matched population (confidence interval, 64.8% to 71.6%). In the elderly grou p of patients, no survival difference was noted: 10-year survival of 4 2.7% versus 45.9% of the age-matched population (confidence interval, 29.8% to 64.6%). Conclusions. An acceptable early mortality and long-t erm survival equal to those seen for an age-matched elderly population are sound outcome measures that support the justification of CABG in older patients irrespective of age.