SPC365

Coronary artery bypass grafting could extend survival in octogenarian patients

Session: Sessão de Posters 25 - Cirurgia cardíaca
Speaker: Inês Sousa

Congress: CPC 2024
Topic: H. Interventional Cardiology and Cardiovascular Surgery
Theme: 26. Cardiovascular Surgery
Subtheme: 26.11 Cardiovascular Surgery - Other
Session Type: Cartazes
FP Number: ---
Authors: Inês Sousa; Sílvia O. Diaz; Rui Cerqueira; Ana Filipa Ferreira; Mário J. Amorim; Paulo Pinho; André P. Lourenço; António S. Barros; Francisca Saraiva; Adelino Leite-Moreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Introduction</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Coronary artery bypass grafting (CABG) is gradually increasing in the octogenarian population due to increasing life expectancy.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Aim</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: To compare long-term survival in octogenarian patients after CABG with a sex and aged-matched general population.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Methods</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Longitudinal, retrospective, single-center study including consecutive patients who underwent primary isolated CABG at an age of 80 or older, between 2004 and 2014. The primary outcome was all-causes mortality accessed in February 2023. Long-term survival was evaluated through survival curve in the octogenarian cohort and general population. Portuguese life tables were taken from the INE (Instituto Nacional de Estat&iacute;stica), specifically for the study period plus follow-up (2004-2022), to estimate the expected number of deaths, using the age-specific death rate. To construct the survival curve for the reference population, estimate standardized mortality ratio (SMR = observed deaths/expected deaths) and to conduct the 1-sample Log-Rank test, comparing expected with observed deaths, we used the software provided by Massachusetts General Hospital Biostatistics Center. The median follow-up was 8 years, maximum of 15 years.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Results</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: Between 2004-2014, 184 octogenarian patients underwent primary isolated CABG, 68% being male, with age between 80 and 88. The majority of patients (73%) presented 3-vessels disease, 76% were classified as class IV according to CCS and 54% had experienced a recent myocardial infarction (&lt;90 days). With respect to surgical techniques, the median [min-max] of implanted grafts was 2.0 [1.0- 5.0], 16% had bilateral internal mammary grafting and 48% were off-pump. Hospital mortality (within 30 days or before hospital discharge) occurred in 5%, the cumulative 1-year survival was 88% and overall mortality occurred in 82% patients. Of note, from the surviving patients in February 2023 (n=34), the median follow-up time was 10 years (ranging from 8 to 14). After excluding patients who had deceased earlier, i.e. before 1-year of follow-up (n=22), survival analysis comparing octogenarian CABG with the expected survival among an age/gender matched sample of the Portuguese population revealed that CABG could extend survival (SMR = 0.67, 95%CI: 0.55-0.82; p&lt; 0.01).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">Conclusion</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Times New Roman&quot;,serif">: This single-center retrospective study evidenced that CABG could offer a significant survival benefit in carefully selected octogenarian patients. Further analyses, with a larger sample, are needed to better understand which clinical characteristics and/or operative details are playing a relevant role on this result. </span></span></span></span></p>