Long term (5 year) results of coronary bypass surgery in patients 65 years old or older: A report from the Coronary Artery Surgery Study

The objective of this study was to evaluate the long-term (5 year) results of isolated coronary bypass surgery in 1086 patients 65 years old or older who were entered into the Coronary Artery Surgery Study (CASS) registry, with particular attention to factors influencing cumulative survival and the symptomatic outcome. Perioperative (30 day) mortality was 5.2% in comparison with 1.9% in 7827 CASS patients less than 65 years old. Cumulative 5 years survival of patients 65 years of age or older was 83%, which was significantly less (p < .0001) than the 91% experienced by patients less than 65 years old. Five year survival was 84% in 795 patients from 65 to 69 years old, 80% in 249 patients from 70 to 74 years old, and 70% in 42 patients 75 years old or older (p < .04). Left ventricular function markedly influenced late survival. Five year survival was 87% in those without wall motion abnormalities; in those with a left ventricular wall motion score of 6 to 10, 11 to 16, and 17 or more, 5 year survival was 86%, 72%, and 67%, respectively. The presence of associated medical diseases significantly affected 5 year survival, which was 80% in those without any associated medical condition and 71% in those with two or more associated medical diseases. Neither the number of diseased vessels nor the number of grafts placed (mean 2.6 per patient) significantly affected 5 year survival. 'Event-free' survival was determined actuarially and death, recurrence of angina, myocardial infarction requiring hospitalization, and repeat bypass surgery were considered events. This survival was significantly better in patients 65 years or older as compared with those less than 65 years old, being 47% and 39%, respectively (p < .001). The actuarially determined recurrence of angina was also less in patients 65 years of age or older (p < .0001). The recurrence of angina and cardiovascular events was significantly higher in men than in women (p < .0001).