Coronary artery bypass grafting in patients over 80 years of age: a single-centre experience

Pietrzyk, Edward; Michta, Kamil; Gorczyca, Iwona; Wożakowska−Kapłon, Beata

doi:10.5603/kp.a2014.0063

Cited by 5 publications

(6 citation statements)

References 15 publications

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“…We observed the lowest O/E ratio in younger patients, with a value of 0.26 for patients <60 years and 0.42 for patients aged 60-69 years, while the ratio was 0.89 in patients ≥ 80 years. This was a surprising result, given that some smaller studies have indicated that EuroSCORE II overestimates mortality in octogenarians [9,10,13]. Hence, our hypothesis that EuroSCORE II would perform less well in octogenarians could not be con rmed, since the discrimination accuracy was only somewhat lower in older patients and the calibration was better.…”

Section: Discussionmentioning

confidence: 78%

“…Previous analyses of cardiac surgery risk scores, including EuroSCORE II, have noted that the scores overestimate the risk of death after CABG in octogenarians [9][10][11][12][13][14] and in high-risk patients [15,16]. However, most of these studies were performed in single-centre cohorts of limited size, and large contemporary population-based studies are lacking.…”

Section: Introductionmentioning

confidence: 99%

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The performance of EuroSCORE II in CABG patients in relation to sex, age, and surgical risk: a nationwide study in 14118 patients

Silverborn

Nielsen

Karlsson

2022

Preprint

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BACKGROUND To determine the discriminative accuracy and calibration of EuroSCORE II in relation to age, sex, and surgical risk in a large nationwide coronary artery bypass grafting (CABG) cohort. METHODS All 14118 patients undergoing isolated CABG in Sweden during 2012–2017 were included. Individual patient data were taken from the SWEDEHEART registry. Patients were divided by age (<60, 60–69, 70–79, ≥80 years), sex, and surgical risk (low: EuroSCORE <4%, intermediate: 4–8%, high: >8%). Discriminative accuracy was determined by the area under the receiver operating characteristic curve (AUC) and calibration by the observed/estimated (O/E) mortality ratio at 30 days. RESULTS AUC and O/E ratio were 0.82 (95% CI: 0.79–0.85) and 0.58 (0.50–0.66) overall, 0.82 (0.79–0.86) and 0.57 (0.48–0.66) in men, and 0.79 (0.73–0.85) and 0.60 (0.47–0.75) in women. Regarding age, discriminative accuracy was highest in patients aged 60–69 years (AUC: 0.86 [0.80–0.93]) but was satisfactory in all groups (AUC: 0.74–0.80). O/E ratio varied from 0.26 for patients >60 years to 0.90 for patients >80 years. Regarding surgical risk, AUC and O/E ratio were 0.63 (0.44–0.83) and 0.18 (0.09–0.30) in low-risk patients, 0.60 (0.55–0.66) and 0.57 (0.46–0.68) in intermediate-risk patients, and 0.78 (0.73–0.83) and 0.78 (0.64–0.92) in high-risk patients. CONCLUSIONS EuroSCORE II had good discriminative accuracy independently of sex and age, but markedly overestimated mortality risk, especially in younger patients. Accuracy and calibration were better in high-risk patients than in low-risk and intermediate-risk patients.

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Section: Discussionmentioning

confidence: 78%

Section: Introductionmentioning

confidence: 99%

The performance of EuroSCORE II in CABG patients in relation to sex, age, and surgical risk: a nationwide study in 14118 patients

Silverborn

Nielsen

Karlsson

2022

Preprint

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“…In the current study data were collected from 51 patients over the age of 80 years underwent coronary artery bypass graft surgery, their mean age was 81.7 years. The outcome of surgery in such an age depends on many factors that those patients could have them like hypertension in 76.5%, renal impairment in 62.7% [10].…”

Section: Discussionmentioning

confidence: 99%

“…Regardless of the presence of diabetes mellitus, single vessel coronary artery disease rather than multivessel disease could happen in younger age group, but was not the case in our study, sample was small in number and most of them were having diabetes. Studies reported that single vessel coronary artery disease occurs more frequently than multiple vessel involvement in younger ages, but the long-term prognosis in young patients having myocardial infarction is unfavorable [10].Supporting the fact that the outcome of the coronary artery bypass graft surgery is not favorable in young age patients, other study reported that the quality of life is significantly improved in patients underwent CABG surgery between the age of 60-69 years, also age group of 50-59 got similar outcome regarding the quality of life but to a lesser extent [11].…”

Section: Discussionmentioning

confidence: 99%

Multivessel Coronary Artery Disease in Diabetes Mellitus Patients

Mohammed

2019

KJAR

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Coronary artery disease is the most common cardiac disease with a worldwide distribution, and it is responsible for most of the mortalities regarding cardiovascular diseases if not detected early and treated properly. There are many lines in the treatment of coronary artery disease, starting from medical therapy, percutaneous coronary intervention, and coronary artery bypass graft surgery, preference of the choice of the type of the treatment depends on many factors. In fact when coronary artery bypass graft is indicated, although it carries a considerable risk of surgery, but the long-term survival is notably better than the other ways of treatment. This study done to determine that the prevalence of multivessel coronary artery disease is more in diabetic patients than non-diabetic patients. And more in female than male. In this study hundred ninety patients were retrospectively studied, all of them underwent coronary artery bypass graft surgery with or without other concomitant cardiac procedure (like valve surgery), but most of them were coronary artery bypass graft alone. We found that the number of the coronary arteries affected is strongly related to the presence of the diabetes mellitus. And females are more prone to have coronary artery disease than male. Thus diabetes mellitus is the most common risk factor for the development of cardiovascular disease, and the severity of the condition is confirmed by the number of the coronary arteries involved as well as the calcification or multiple stenosis in the same vessel.

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“…Routinely, in our study patients were evaluated using a scale of perioperative risk – the European System for Cardiac Operative Risk Evaluation (EuroSCORE) – and assessed by the Heart Team, and thus disqualified from operations. However, it was reported that in the group of octogenarians in 62.7% with impaired renal function preoperative mortality risk assessment determined on the basis of EuroSCORE I and EuroSCORE II may be overestimated [ 24 ]. Very common undertreatment can contribute to high and excess mortality of the oldest cardiorenal patients.…”

Section: Discussionmentioning

confidence: 99%

HEART AND LUNG FAILURE, TRANSPLANTOLOGY The impact of chronic kidney disease on the annual prognosis in patients 80+ years old suffering from chronic heart failure

Cichocka-Radwan

Ciurus

Lelonek

2014

kitp

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IntroductionIt is well known that the function of kidneys is impaired with age.AimThe purpose of the study was to evaluate whether chronic kidney disease (CKD) is a predictor for 1-year follow-up mortality among hospitalized chronic heart failure (CHF) patients aged 80+.Material and methodsThe study included 141 consecutive patients aged 80-92 (mean: 82.4 years, 44.7% men). The prospective analysis contains 61 variables with glomerular filtration rate (GFR) and the occurrence of death at the 1-year follow-up. Patients were divided and analyzed depending on GFR.ResultsChronic kidney disease defined as estimated GFR < 60 ml/min/1.73 m2 was recorded in 93 patients (66%). A relationship with GFR < 60 was found for older age (p = 0.0001), lower body mass index – BMI (p = 0.003), more advanced NYHA class III (p = 0.007), higher concentrations of N-terminal probrain natriuretic peptide – NT-proBNP (p = 0.023), lower hemoglobin (p = 0.0004) and LVEF (p = 0.005), longer hospitalization (p = 0.005), more frequent ventricular blocks in ECG (p = 0.017) and rarely performed coronary angiography (p = 0.021). In turn, GFR < 30 ml/min/1.73 m2 was recorded in 14 patients (9.9%). Similar relationships as in GFR < 60 were found for GFR < 30 and additionally higher concentrations of high-sensitivity C-reactive protein (hsCRP) (p = 0.003), D-dimer (p = 0.002) and more frequent dyslipidemia (p = 0.004) and left main coronary artery disease (p = 0.007). Annual mortality for the total population was 14.2% (n = 20) and was higher (16.1%) if GFR was < 60 and even more (21.4%) in GFR < 30. However, the relationship between deaths and GFR was not statistically significant (for GFR < 60, p = 0.505 and GFR < 30, p = 0.547).ConclusionsAnnual mortality in the patients 80+ who suffered from CHF was high but not statistically significantly associated with CKD.

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Coronary artery bypass grafting in patients over 80 years of age: a single-centre experience

Cited by 5 publications

References 15 publications

The performance of EuroSCORE II in CABG patients in relation to sex, age, and surgical risk: a nationwide study in 14118 patients

The performance of EuroSCORE II in CABG patients in relation to sex, age, and surgical risk: a nationwide study in 14118 patients

Multivessel Coronary Artery Disease in Diabetes Mellitus Patients

HEART AND LUNG FAILURE, TRANSPLANTOLOGY The impact of chronic kidney disease on the annual prognosis in patients 80+ years old suffering from chronic heart failure

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