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.

Abstract

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.