15-YEAR TRENDS IN RISK SEVERITY AND OPERATIVE MORTALITY IN ELDERLY PATIENTS UNDERGOING CORONARY-ARTERY BYPASS GRAFT-SURGERY

Background-Trends in risk-severity and operative mortality (OM) were e xamined in 3330 consecutive patients aged 70 years and older who under went isolated coronary artery bypass graft surgery (CABG) between 1982 and 1996. Methods and Results-The proportion of elderly patients rose significantly over time (P<.001). Crude OM among the elderly was 7.2% in 1982 to 1986, fell to 4.4% in 1987 to 1991, but did not improve th ereafter. Logistic regression analysis of OM was used to construct rel ative risk groups (low, medium, or high). The prevalence of high-risk elderly patients rose significantly over time (P=.001) from 16.2% in 1 982 to 1986 to 19.5% in 1987 to 1993 and 26.9% in 1993 to 1996. OM in high-risk patients fell significantly (P=.044) from 17.2% in 1982 to 1 986 to 9.1% in 1987 to 1991 and was 8.9% in 1993 to 1996. Contemporary independent predictors of OM among elderly patients were poor ventric ular function (LV grade 2 to 3, odds ratio [OR], 2.6; 95% confidence i nterval [CI], 1.3 to 5.2; and LV grade 4, OR, 10.7; 95% CI, 4.4 to 26) ; previous CABG (OR, 3.7; 95% CI, 2.0 to 7.0), female sex (OR, 1.8; 95 % CI, 1.1 to 2.8), peripheral vascular disease (OR, 1.8; 95% CI, 1.1 t o 2.8), and diabetes (OR, 1.7; 95% CI, 1.1 to 2.7). Previous angioplas ty was protective (OR, 0.3; 95% CI, 0.1 to 0.9). Conclusions-OM in eld erly patients has declined significantly in recent years despite an in crease in the prevalence and severity of their risk factors. A careful weighing of risk, rather than advanced age alone, should determine wh o is offered surgical revascularization. In this regard, poor ventricu lar function and repeat CABG continue to have the greatest impact on O M in elderly patients.