Long-term survival of the very elderly undergoing coronary artery bypass grafting.
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.
Likosky
Donald S
DS
Department of Surgery, Dartmouth Medical School, Hanover, New Hampshire 03756, USA. donald.likosky@dartmouth.edu
Dacey
Lawrence J
LJ
Baribeau
Yvon R
YR
Leavitt
Bruce J
BJ
Clough
Robert
R
Cochran
Richard P
RP
Quinn
Reed
R
Sisto
Donato A
DA
Charlesworth
David C
DC
Malenka
David J
DJ
MacKenzie
Todd A
TA
Olmstead
Elaine M
EM
Ross
Cathy S
CS
O'Connor
Gerald T
GT
D000367:Age Factors; D000369:Aged, 80 and over; D015331:Cohort Studies; D016001:Confidence Intervals; D017023:Coronary Angiography; D001026:Coronary Artery Bypass / Q000379:methods / Q000401:mortality*; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D015577:Geriatric Assessment; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009511:New England; D011336:Probability; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors