Outcomes of coronary artery bypass grafting in elderly patients: A comprehensive analysis of different surgical approaches (from the KROK Registry).

Abstract

Background: Coronary artery revascularization is vital for managing coronary artery disease, especially in elderly patients with multiple comorbidities.

Aims: To evaluate the outcomes of coronary artery bypass surgery in patients aged ≥75 years, focusing on the survival benefits of different surgical techniques and graft types.

Material and methods: This retrospective cohort study analyzed data from the Polish National Registry of Cardiac Surgery Procedures (2012-2022) for patients aged ≥75 years undergoing isolated coronary artery bypass surgery.

Results: We analysed 18 215 patients: 12 843 patients were under 80 years old; 4689 were between 80 and 84 years old; and 683 were ≥85 years old. Key preoperative risk factors associated with increased hospital mortality included extracardiac arteriopathy, atrial fibrillation, chronic renal failure, recent myocardial infarction, and poor mobility. The median follow-up time was 4.8 years (interquartile range 2.37-7.27). On-pump coronary artery bypass grafting (ONCAB) demonstrated a significant long-term benefit in patients aged <80 years. The use of an internal mammary artery graft provided significant survival advantages for those <85 years old, but this benefit was not observed in patients aged ≥85 years (P = 0.73). Multiarterial grafting did not demonstrate a significant survival advantage across all age groups.

Conclusions: In patients ≥80 years old there was no survival benefit between ONCAB and off-pump coronary bypass grafting. However, ONCAB was associated with significantly improved survival outcomes in younger patients. The internal mammary artery graft improved long-term survival in patients <85 years old, while additional arterial grafts did not confer a survival benefit in the elderly population.