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Original Articles: Adult Cardiac

Long-Term Survival of the Very Elderly Undergoing Coronary Artery Bypass Grafting

^a Departments of Surgery, and Community and Family Medicine, and The Dartmouth Institute for Health Policy and Clinical Practice, Dartmouth Medical School, Hanover, New Hampshire
^b Dartmouth-Hitchcock Medical Center, Hanover, New Hampshire
^c Catholic Medical Center, Manchester, New Hampshire
^d Fletcher Allen Health Care, Burlington, Vermont
^e Eastern Maine Medical Center, Bangor, Maine
^f Central Maine Medical Center, Lewiston, Maine
^g Maine Medical Center, Portland, Maine
^h Portsmouth Regional Hospital, Portsmouth, New Hampshire
ⁱ Dartmouth Medical School, Hanover, New Hampshire

Accepted for publication December 26, 2007.

^_* Address correspondence to Dr Likosky, Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH 03756 (Email: donald.likosky{at}dartmouth.edu).

Background: Increasing numbers of the very elderly are undergoing coronary artery bypass graft surgery (CABG). Short-term results have been studied, but few data are available concerning long-term outcomes.

Methods: We conducted a cohort study of 54,397 consecutive patients undergoing primary, isolated CABG surgery between July 1, 1987, and June 30, 2006. Patient records were linked to the Social Security Administration’s Death Master File.

Results: During 390,871 person-years of follow-up, there were 17,352 deaths. There were 51,149 patients younger than 80 years, 2,661 patients aged 80 to 84 years, and 587 patients aged 85 or more years who underwent isolated CABG surgery. Crude in-hospital survival was 97.2% for those less than 80 years, 98.3% for those aged 80 to 84 years, and 87.6% for those aged 85 or more years. Patients aged 80 or more years were more likely to be female (46.9%), more likely to be emergency priority (10.2%), and more likely to have associated comorbidities than younger patients. Patients aged 85 or more years were more likely to have intraoperative and postoperative morbid events. Among patients younger than 80, median survival was 14.4 years with an annual incidence of death of 4.2%. Among patients 80 to 84 years old, median survival time was 7.4 years, with an annual incidence rate of death of 10.3%. Among patients aged 85 or more years, median survival was 5.8 years, and the annual incidence of death was 13.7%.

Conclusions: Although very elderly CABG patients have more comorbidities and more acute presentation than younger patients and their in-hospital mortality rate is high, their long-term survival is surprisingly good.

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