[Coronary surgery in patients over 65 year of age].

UNLABELLED

The aim of the study was to analyze the risk and operative results in bypassed patients with ischemic heart disease (IHD) older than 65 years.

MATERIAL

The study group was 117 patients over 65 years old (66-87, mean 71 years) and the controls were 233 patients below 65 years old (31-64, mean 51 years), who underwent coronary artery grafting.

METHODS

The frequency of such risk factors as diabetes, smoking, hypertension and IHD and myocardial infarction (MI) family history were performed. Theoretical operative risk in study group and in control group were estimated using: Parsonnette, The Cleveland Clinic Foundation and Euro Score scales. The number of anastomoses, the frequency of using the internal mammary artery (IMA) graft to left anterior descending (LAD) coronary artery and perfusion, aorta clamping and repercussion times were compared in both groups. The operative mortality, Q wave MI and stroke were analysed in study and control groups as the operative results.

RESULTS

There was the higher percent of women and patient with hypertension and lower percent of smokers in the study group. The total cholesterol, HDL-cholesterol, LDL-cholesterol, PAI-1, fibrinogen, creatinine levels and the number of the patients with cerebral or peripheral atherosclerosis were similar in both groups. The triglycerides level was higher in the study group. In the study group the use of IMA, as the conduit was lower. There was no difference in the perfusion time, aorta clamping time and reperfusion time. An operative mortality was higher in the older group (8.5% vs 2.6%; p < 0.05). The perioperative Q wave MI rate was 7.7% and 4.3% (ns) and stroke rate was 3.4% and 2.6% (ns). Estimated in our patients, theoretical operative mortality in the study group was 6.5-8.7% and in the control group was 2.1-2.7%, and there was no statistical differences compare to real operative mortality. The most adequate to real mortality was theoretical mortality estimated using EuroScore scale.

CONCLUSIONS

1. Coronary bypass surgery mortality was higher in the patients over 65 years old and the myocardial infarction was the main reason of death. 2. Using operative risk scales, the prognosis individual operative risk mortality to every patient can be estimated and if this risk is too high it is possible to eliminate some risk factors or desist from operative treatment.