title: The impact of complete revascularization on long-term survival is strongly dependent on age.
abstract: BACKGROUND
  Complete revascularization during coronary artery bypass grafting (CABG) has been reported to be associated with better short-term and long-term outcomes. We hypothesized that the survival benefit of complete revascularization would be less in old patients than in young patients.
  
  
  METHODS
  We analyzed data from 6,539 consecutive patients who had undergone a first isolated on-pump CABG procedure between 2000 and 2008. We investigated the impact of complete revascularization and its interaction with age on operative and long-term survival using propensity-score-based analyses.
  
  
  RESULTS
  Patients with incomplete (versus complete) revascularization (n=318 [4.9%]) were sicker overall. During a mean follow-up of 5.8±2.2 years, 909 patients died. In the propensity-score-matched analysis, operative mortality was not significantly different between patients with complete revascularization and those with incomplete revascularization (1.9% versus 2.8%; odds ratio [OR], 1.46; 95% confidence interval [CI], 0.56-3.46; p=0.48). In contrast, incomplete revascularization had an independent negative impact on long-term survival, which was strongly age dependent (hazard ratio [HR] for interaction, 0.96 per year increment; p=0.02). In a propensity-score-matched analysis, incomplete revascularization was independently associated with higher long-term mortality in patients younger than 60 years (HR, 3.27; 95% CI, 1.21-8.86; p=0.02), whereas it was not in patients 60 to 70 years and 70 years of age and older (p=0.87 and p=0.24, respectively).
  
  
  CONCLUSIONS
  Contrary to what is observed in patients younger than 60 years, complete revascularization does not seem to improve long-term survival in older patients. This suggests that elderly patients at high operative risk may be considered, when deemed clinically appropriate, for limited coronary revascularization.
authors: Hospices Civils de Lyon, Service de Biostatistique, Lyon, France.
authors: Nicolas
authors: N
authors: Girerd
authors: Julien
authors: J
authors: Magne
authors: Muriel
authors: M
authors: Rabilloud
authors: Eric
authors: E
authors: Charbonneau
authors: Siamak
authors: S
authors: Mohamadi
authors: Philippe
authors: P
authors: Pibarot
authors: Pierre
authors: P
authors: Voisine
authors: Richard
authors: R
authors: Baillot
authors: Daniel
authors: D
authors: Doyle
authors: Eric
authors: E
authors: Dumont
authors: François
authors: F
authors: Dagenais
authors: Patrick
authors: P
authors: Mathieu
mesh_terms: D000367:Age Factors; D000368:Aged; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000401:mortality* / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011792:Quebec / Q000453:epidemiology; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome