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.

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Abstract
Of 2144 patients aged .gtoreq. 65 yr entered into the registry of the Coronary Artery Surgery Study (CASS) and who had coronary arteriography, 1086 underwent isolated coronary artery bypass grafting. Complications of antiography included death in 4 patients and nonfatal myocardial infarction in 17. Eight patients suffered neurologic complications, which were transient in 5. 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 < 65 yr entered in CASS (P < 0.001). There was a trend toward an increased mortality rate with age; it was 4.6% (37 of 803) in patients aged 65-69 yr, 6.6% (16 of 241) in those 70-74 yr old and 9.5% (4 of 42) in those .gtoreq. 75 yr. The duration of hospital stay after operation was significantly longer for the patients .gtoreq. 65 yr than for the patients < 65 yr (13.3 vs. 11.4 days; P < 0.001). Stepwise linear discriminant analysis identified 5 variables predictive of perioperative mortality: presence of .gtoreq. 70% 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 1 or more associated medical diseases. A 2nd linear discriminant analysis, incorporating 7658 CASS patients who underwent isolated coronary artery bypass surgery irrespective of age, examined whether age .gtoreq. 65 yr 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 .gtoreq. 65 yr, left ventricular wall motion score, sex and history of unstable angina pectoris. In patients .gtoreq. 65 yr, the mortality from coronary arteriography is low, whereas mortality from coronary artery bypass surgery is greater than that in CASS patients < 65 yr.

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