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. 2009 Sep 15;120(11 Suppl):S65-9.
doi: 10.1161/CIRCULATIONAHA.108.844316.

Evaluation of revascularization subtypes in octogenarians undergoing coronary artery bypass grafting

Abdulhameed Aziz  1 , Anson M Lee, Michael K Pasque, Jennifer S Lawton, Nader Moazami, Ralph J Damiano Jr, Marc R Moon
Affiliations

Evaluation of revascularization subtypes in octogenarians undergoing coronary artery bypass grafting

Abdulhameed Aziz et al. Circulation. .

Abstract

Background: Recent data suggest that octogenarians' long-term survival after complete coronary artery bypass graft revascularization is superior to incomplete revascularization. Discriminating between variable definitions of "complete" complicates interpretation of survival data. We aimed to clarify octogenarian long-term survival rates by stratifying revascularization subtypes.

Methods and results: From 1986 to 2007, 580 patients 80 to 94 years of age underwent coronary artery bypass graft. Functional complete revascularization was defined as at least 1 graft to all diseased coronary vessels with >50% stenosis. Traditional complete revascularization was defined as 1 graft to each major arterial system with at least 50% stenosis. Incomplete revascularization was defined as leaving diseased, ungrafted regions. Revascularization was functional in 279 (48%), traditional in 181 (31%), and incomplete in 120 (21%). Long-term survival was evaluated by Kaplan-Meier analysis. Of 537 operative survivors, there were 402 late deaths. Cumulative long-term survival totaled 2890 patient-years. Late survival (Kaplan-Meier) was similar between functional (mean, 6.8 years) and traditional (6.7 years) groups (P=0.51), but diminished with incomplete (4.2 years) revascularization (P=0.007). Survival by group at 5 years was: 59+/-3% functional, 57+/-4% traditional, and 45+/-5% incomplete. Survival at 8 years was: 40+/-3% functional, 37+/-4% traditional, and 26+/-5% incomplete. To minimize selection bias in patients with limited life expectancy, Kaplan-Meier analysis was repeated including only patients with survival >12 months. Survival was again impaired with incomplete revascularization (P=0.04), and there was no difference between functional and traditional complete revascularization (P=0.73).

Conclusions: Bypassing all diseased arterial vessels after revascularization does not afford significant long-term survival advantage compared to a traditional approach. Incomplete revascularization, related to more extensive disease, is associated with an 18% decline in survival. These data suggest that it is important to avoid incomplete revascularization in octogenarians, but the supplementary endeavor required to perform functional complete revascularization does not improve survival.

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Conflict of interest statement

Disclosures

There are no potential conflicts of interest from any of the authors in relation to information conveyed from this manuscript.

Figures

Figure 1
Figure 1
Long-term survival for octogenarians undergoing first-time, isolated coronary artery bypass grafting stratified by revascularization subtype. The numbers of patients at risk for each revascularization subtype are reported at 0, 2, 4, 6, 8, and 10 years.
See this image and copyright information in PMC

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