Fifteen-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 examined in 3330 consecutive patients aged 70 years and older who underwent isolated coronary artery bypass graft surgery (CABG) between 1982 and 1996.


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 thereafter. Logistic regression analysis of OM was used to construct relative risk groups (low, medium, or high). The prevalence of high-risk elderly patients rose significantly over time (P=.001) from 16.2% in 1982 to 1986 to 19.5% in 1987 to 1991 and 26.9% in 1992 to 1996. OM in high-risk patients fell significantly (P=.044) from 17.2% in 1982 to 1986 to 9.1% in 1987 to 1991 and was 8.9% in 1992 to 1996. Contemporary independent predictors of OM among elderly patients were poor ventricular function (LV grade 2 to 3, odds ratio [OR], 2.6; 95% confidence interval [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 to 2.8), and diabetes (OR, 1.7; 95% CI, 1.1 to 2.7). Previous angioplasty was protective (OR, 0.3; 95% CI, 0.1 to 0.9).


CONCLUSIONS
OM in elderly patients has declined significantly in recent years despite an increase in the prevalence and severity of their risk factors. A careful weighing of risk, rather than advanced age alone, should determine who is offered surgical revascularization. In this regard, poor ventricular function and repeat CABG continue to have the greatest impact on OM in elderly patients.
Ivanov
J
J
Division of Cardiovascular Surgery, The Toronto Hospital, The University of Toronto, Ontario, Canada.
Weisel
R D
RD
David
T E
TE
Naylor
C D
CD
D017677:Age Distribution; D000368:Aged; D015331:Cohort Studies; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D003327:Coronary Disease / Q000453:epidemiology / Q000601:surgery; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009026:Mortality / Q000639:trends; D016017:Odds Ratio; D009864:Ontario / Q000453:epidemiology; D016491:Peripheral Vascular Diseases / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology; D012306:Risk; D017678:Sex Distribution; D016896:Treatment Outcome; D016277:Ventricular Function, Left