CABG may improve survival in octogenarians
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Among octogenarians, patients who underwent CABG had longer survival times compared with age- and sex-matched individuals who did not, researchers reported in Mayo Clinic Proceedings.
“We felt our surgical outcomes on octogenarians with coronary bypass surgery are as good as younger patients. However, physicians, patients and even surgeons are still avoiding doing the big surgery on patients 80 years or older since classically they were considered as high risk-patients,” Kukbin Choi, MD, cardiovascular surgery fellow at the Mayo Clinic, told Healio. “So, we wanted to have some evidence to convince everyone, including ourselves.”
Choi and colleagues conducted a retrospective cohort study of 1,283 octogenarians (median age, 83 years; 68% men; 82.9% with three-vessel CAD) who underwent CABG at the Mayo Clinic between January 1993 and October 2019.
Outcomes of interest included survival, temporal trends in survival and risk factors for mortality. Median follow-up was 16.7 years.
During the study period, the operative mortality rate was 4% but declined over time (P = .015); for example, the operative mortality rate was 6.4% during the first 3 years and 0% during the last 3 years, according to the researchers.
The Kaplan-Meier estimated survival rates were 90.2% at 1 year, 67.9% at 5 years, 31.1% at 10 years and 8.2% at 15 years.
Compared with age- and sex-matched octogenarians in the U.S. population, the Mayo Clinic CABG cohort had a longer median survival time (7.6 years vs. 6 years; P < .001), Choi and colleagues found.
“Coronary bypass surgery is a good option even in octogenarians and may provide enough benefit with comparable operative risk,” Choi told Healio. “My grandfather is 82 but he is still very active without any other medical issues. If he gets coronary disease, I would definitely recommend CABG if indicated. Because I don’t want to limit his survival by judging his life expectancy too early.”
In a Cox regression analysis, the researchers identified the following as risk factors for reduced survival time: older age (P < .001), diabetes (HR = 1.34; 95% CI, 1.16-1.56; P < .001), recent atrial fibrillation or flutter (HR = 1.43; 95% CI, 1.19-1.72; P < .001), high rate of Society of Thoracic Surgeons Predicted Risk of Mortality score (P = .01), extreme high and low creatinine levels (P < .001), lower ejection fraction (P = .03), history of smoking (HR = 1.22; 95% CI, 1.06-1.4; P = .006), immunosuppressed status (HR = 1.48; 95% CI, 1.09-2.01; P = .01), peripheral vascular disease (HR = 1.21; 95% CI, 1.03-1.43; P = .02), chronic lung disease (HR = 1.26; 95% CI, 1.03-1.54; P = .02) and cerebrovascular disease (HR = 1.19; 95% CI, 1.01-1.4; P = .04).
“We need further study to identify the subgroups benefiting more from CABG,” Choi told Healio. “But theoretically, patients who may live longer than 5 to 10 years if no coronary disease can have benefit from CABG since it provides better mid- and long-term survival than other options.”
For more information:
Kukbin Choi, MD, can be reached at Department of Cardiovascular Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.
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