Complete Coronary Revascularization Improves Survival in Octogenarians.
BACKGROUND
Completeness of revascularization is important for patients undergoing coronary artery bypass graft surgery, but information on its long-term impact in octogenarian patients is lacking.


METHODS
From 1986 to 2004, 525 consecutive patients aged 80 years or more (mean age 82 ± 3 years) underwent coronary artery bypass graft surgery and were followed for a minimum of 10 years or until death. Outcome was stratified based on extent of revascularization, defined as total (graft to every diseased vessel), complete (graft to each region but not every diseased vessel), or incomplete (bypass not done to all suitable regions or vessels).


RESULTS
Follow-up of 3,155 patient-years (mean follow-up 73 ± 54 months) was 99% complete. Overall operative mortality was 8% (41 of 525), and was lower for elective than for urgent/emergent cases (4.2% versus 16% ± 6%, p < 0.001, respectively). There was a trend toward higher operative mortality with incomplete (13% ± 6%) versus complete (8% ± 4%) or total revascularization (6% ± 3%; p = 0.09). For operative survivors, mean survival was significantly improved with total and complete revascularization (6.9 and 6.8 years, respectively), compared with incomplete revascularization (5.4 years, p < 0.008). For total, complete, and incomplete revascularization, survival at 5 years was 61% ± 3%, 61% ± 4%, and 47% ± 5%, respectively. Ten-year survival was 27% ± 3%, 21% ± 3%, and 16% ± 4% (p = 0.01), respectively, in these groups.


CONCLUSIONS
Incomplete revascularization in octogenarians is associated with decreased long-term survival when compared with total or complete revascularization. There was no survival benefit with total over complete revascularization. Octogenarians can have good long-term survival, especially with adequate revascularization.
Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri. Electronic address: melbys@wustl.edu.
Spencer J
SJ
Melby
Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
Lindsey L
LL
Saint
Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
Keki
K
Balsara
Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
Akinobu
A
Itoh
Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
Jennifer S
JS
Lawton
Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
Hersh
H
Maniar
Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
Michael K
MK
Pasque
Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
Ralph J
RJ
Damiano
Division of Cardiothoracic Surgery, Department of Surgery, Washington University in St. Louis, St. Louis, Missouri.
Marc R
MR
Moon
D000367:Age Factors; D000369:Aged, 80 and over; D002423:Cause of Death / Q000639:trends; D003324:Coronary Artery Disease / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008923:Missouri / Q000453:epidemiology; D009204:Myocardial Revascularization / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome