From the Division of Cardiovascular Surgery (J.I., R.D.W., T.E.D.), The
Toronto Hospital, Toronto Ontario; The Institute for Clinical Evaluative
Sciences (C.D.N.), North York, Ontario; The University of Toronto (J.I.,
R.D.W., T.E.D., C.D.N.), Toronto, Ontario; and The Clinical Epidemiology and
Health Services Research Program (C.D.N.), Sunnybrook Health Science Centre,
North York, Ontario, Canada.
Correspondence to Dr C. David Naylor, Institute for Clinical Evaluative Sciences, G106–2075 Bayview Ave, North York, Ontario, Canada M4N 3M5. E-mail cdn{at}ices.on.ca
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.
Methods and 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.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Fifteen-Year Trends in Risk Severity and Operative Mortality in Elderly Patients Undergoing Coronary Artery Bypass Graft Surgery
Key Words: risk factors • bypass • coronary disease • mortality • surgery
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