Thorac Cardiovasc Surg 2024; 72(S 01): S1-S68
DOI: 10.1055/s-0044-1780589
Sunday, 18 February
Langzeitergebnisse nach koronarer Bypass-Operation

Long-Term Survival in Elderly Patients after Coronary Artery Bypass Grafting Compared to the Age-Matched General Population—A Meta-analysis of Reconstructed Time-to-event Data

Authors

  • H. Kirov

    1   Friedrich-Schiller-University, Jena, Deutschland

  • T. Caldonazo

    2   Jena University Hospital, Jena, Deutschland

  • S. Toshmatov

    2   Jena University Hospital, Jena, Deutschland

  • P. Tasoudis

    3   University of North Carolina, Chapel Hill, United States

  • M. Mukharyamov

    4   University Hospital of Friedrich-Schiller-University Jena, Jena, Deutschland

  • M. Diab

    5   Herz-Kreislauf-Zentrum Rotenburg a. d. Fulda, Rotenburg an der Fulda, Deutschland

  • T. Doenst

    2   Jena University Hospital, Jena, Deutschland
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Background: Atherosclerotic coronary artery disease (CAD) limits life expectancy compared to the general population. Myocardial infarctions (MI) are the primary cause of death. The incidence of MI increases progressively with age and most MI deaths occur in the population older than 70 years. Coronary artery bypass grafting (CABG) may prevent the occurrence of new MIs by bypassing most CAD lesions, providing downstream “collateralization” to the diseased vessel. We systematically assessed the survival-improving potential of CABG by comparing elderly CABG patients to the age-matched general population.

Methods: Three databases were assessed (MEDLINE, ScienceDirect and Cochrane Library). Primary and single outcome was long-term all-cause mortality. Reconstruction of individual patient survival data (IPD) was performed. As a sensitivity analysis, summary hazard ratios (HR) and 95% confidence intervals (CI) for all individual studies based on the reconstructed IPD were pooled for a conventional two-stage meta-analysis.

Results: A total of 1,352 studies were retrieved. Four studies and 6,917 patients were included in the analysis. Elderly patients (>70 years) who underwent CABG had significantly lower risk of death in the follow-up compared to the general age-matched population in the one-stage (HR: 0.88, 95% CI: 0.83–0.94, p < 0.001) and in the two-stage survival analysis (HR 0.89, 95% CI 0.80–0.99, p = 0.03).

Conclusion: Elderly patients (>70 years) who undergo CABG appear to have significantly better long-term survival compared to the age-matched general population. This advantage becomes visible after the first year and underscores the life-prolonging effect of bypass surgery, which may eliminate the expected reduction in life expectancy through CAD.


No conflict of interest has been declared by the author(s).

Publication History

Article published online:
13 February 2024

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