CORONARY REVASCULARIZATION IN THE ELDERLY - DETERMINANTS OF OPERATIVEMORTALITY

Over a 13-year period, 668 patients 70 years of age or older underwent isolated primary coronary artery bypass grafting at our institution. There were 472 men and 196 women, ranging from 70 to 90 years of age ( median age, 74 years). Hospital mortality was 5.2% (35/668). In patien ts 70 to 79 years of age, hospital mortality was 4.2% (25/600), wherea s in patients 80 years of age or older, mortality was 14.7% (10/68; p < 0.001). Twenty-seven clinical or hemodynamic variables hypothesized as predictors of operative mortality were examined. Mortality was high er in women than in men (9% versus 3.6%; p = 0.006). Those who died we re a mean of 3 years older (77 versus 74 years old; p < 0.05) and were more likely to have unstable angina or Canadian class III or IV angin a (p < 0.01), Patients requiring urgent operations, preoperative intra aortic balloon assist, intravenous nitroglycerin, or inotropic agents, and those with preoperative hypotension or cardiac arrest were most l ikely to die in the hospital (p < 0.001). Multivariate logistic regres sion analysis revealed advancing age, female sex, bypass time, urgency of operation, preoperative cardiac arrest, and unstable angina as pri mary determinants of mortality (p < 0.05). Although mortality after co ronary artery bypass grafting increases with age, the greatest risk of death is in the acutely ill patient with few options for management o ther than surgical intervention.