Circulation, Vol 67, 483-491, Copyright © 1983 by American Heart Association
BJ Gersh, RA Kronmal, RL Frye, HV Schaff, TJ Ryan, AJ Gosselin, GC Kaiser and T Killip 3d
Of 2144 patients age 65 years or older entered into the registry of the
Coronary Artery Surgery Study (CASS) who had coronary arteriography, 1086
underwent isolated coronary artery bypass grafting. Complications of
angiography included death in four patients and nonfatal myocardial
infarction in 17. Eight patients suffered neurologic complications, which
were transient in five. The perioperative mortality was 5.2% (57 of 1086),
which is significantly greater than the perioperative mortality of 1.9%
(151 of 7827) in patients younger than 65 years entered in CASS (p less
than 0.001). There was a trend toward an increased mortality rate with age;
it was 4.6% (37 of 803) in patients age 65-69 years, 6.6% (16 of 241) in
those 70-74 years and 9.5% (four of 42) in those 75 years or older. The
duration of hospital stay after operation was significantly longer for the
patients 65 years or older than for the patients younger than 65 (13.3 vs
11.4 days; p less than 0.001). Stepwise linear discriminant analysis
identified five variables predictive of perioperative mortality: presence
of 70% or more stenosis of the left main coronary artery and a
left-dominant circulation, left ventricular end-diastolic pressure, a
history of current cigarette smoking, pulmonary rales on auscultation, and
presence of one or more associated medical diseases. A second linear
discriminant analysis, incorporating 7658 CASS patients who underwent
isolated coronary artery bypass surgery irrespective of age, examined
whether age 65 years or older was an independent predictor of perioperative
mortality. The variables selected, in order of significance, were
congestive cardiac failure score, left main coronary artery stenosis and a
left-dominant circulation, age 65 years or older, left ventricular wall
motion score, sex and history of unstable angina pectoris. In patients 65
years or older, the mortality from coronary arteriography is low, whereas
mortality from coronary artery bypass surgery is greater than that in CASS
patients younger than 65 years.
ARTICLES
Coronary arteriography and coronary artery bypass surgery: morbidity and mortality in patients ages 65 years or older. A report from the Coronary Artery Surgery Study
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