Objective: The objective of this retrospective cohort study was to determine whether coronary artery bypass graft (CABG) surgery is effective and cost-effective relative to medical management of coronary artery disease (CAD) in the elderly.
Summary Background Data: The aging of the U.S population and the improvements in surgical techniques have resulted in increasing numbers of elderly patients who undergo this surgery. The three randomized, controlled trials (RCTs) that established the efficacy of CABG surgery completed patient enrollment from 19 to 24 years ago excluded patients older than 65 years. Although information regarding outcomes of CABG in this population is mainly available in case series, a major lacuna exists with respect to information on quality of life and cost effectiveness of surgery as compared with medical management.
Methods: The authors retrospectively formed surgical and medically managed cohorts of octogenarians with significant multivessel CAD. More than 600 medical records of patients older than 80 years who underwent angiography at our institution were reviewed to identify 48 patients who were considered reasonable surgical candidates but had not undergone surgery. This cohort was compared with 176 patients who underwent surgery.
Results: The cost per quality-adjusted life year saved was $10,424. At 3 years, survival in the surgical group was 80% as compared with 64% in the entire medical cohort and 50% in a smaller subset of the medical cohort. Quality of life in patients who underwent surgery was measurably better than that of the medical cohort with utility index scores, as measured by the EuroQoL, (a seven-item quality of life questionnaire) of 0.84, 0.61, and 0.74, respectively.
Conclusions: Performing CABG surgery in octogenarians is highly cost-effective. The quality of life of the elderly who elect to undergo CABG surgery is greater than that of their cohorts and equal to that of an average 55-year-old person in the general population.
Download full-text PDF |
Source |
|---|---|
| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1191481 | PMC |
| http://dx.doi.org/10.1097/00000658-199809000-00003 | DOI Listing |
Publication Analysis
Top Keywords
Similar Publications
Assessing the Predictive Impact of Preoperative Lactate Dehydrogenase to Albumin Ratio on Outcomes Following Coronary Artery Bypass Graft Surgery.
J Clin Med
January 2025
Cardiovascular Surgery, School of Medicine, Kocaeli University, Kocaeli 41001, Turkey.
The lactate dehydrogenase to albumin ratio (LAR) is a novel inflammatory marker and a potential predictor of mortality in various conditions. No research has yet examined LAR's impact on mortality in cardiac surgery patients. This study evaluated LAR's role in predicting mortality and complications in isolated coronary artery bypass grafting (CABG) patients.
View Article and Find Full Text PDFThe Efficacy of the Charlson Comorbidity Index and Its Age-Adjusted Version in Forecasting Mortality and Postoperative Outcomes Following Isolated Coronary Artery Bypass Grafting.
J Clin Med
January 2025
Department of Cardiovascular Surgery, School of Medicine, Kocaeli University, 41001 Kocaeli, Turkey.
: The Charlson Comorbidity Index (CCI) is designed for evaluating comorbidities and mortality risks, with the age-adjusted CCI (ACCI) combining age and comorbidity assessments. Despite its long-standing use, research on CCI's application in cardiac surgery patients is limited. This study assessed the effectiveness of CCI and ACCI in predicting in-hospital mortality and post-surgery outcomes for patients undergoing isolated coronary artery bypass grafting (CABG).
View Article and Find Full Text PDFDynamics of Glycemic Status and Glucose Metabolism Markers 12 Months After Coronary Artery Bypass Grafting and Their Relationship with the Annual Prognosis of Patients.
J Clin Med
January 2025
Federal State Budgetary Scientific Institution, Research Institute for Complex Issues of Cardiovascular Diseases, Academician LS Barbarash Boulevard, 6, Kemerovo 650002, Russia.
We aim to evaluate the dynamics of glycemic status and markers of carbohydrate metabolism 12 months after coronary artery bypass grafting (CABG) and their relationship with the one-year prognosis. The analysis of outcomes of 653 patients during 1 year after coronary artery bypass grafting is presented. In those patients who visited the study center after 1 year, markers of carbohydrate metabolism (glucose, glycated hemoglobin, fructosamine, 1.
View Article and Find Full Text PDFEndothelial Dysfunction and Oxidative Stress in Patients with Severe Coronary Artery Disease: Does Diabetes Play a Contributing Role?
Medicina (Kaunas)
January 2025
Faculty of Medicine, Transilvania University of Brasov, 500036 Braşov, Romania.
: Endothelial dysfunction (ED) and oxidative stress play major contributions in the initiation and progression of atherosclerosis. Diabetes is a pathological state associated with endothelial damage and enhanced oxidative stress. This study evaluated endothelial dysfunction and oxidative stress in patients with severe coronary artery disease (CAD) undergoing coronary artery bypass graft (CABG) surgery, comparing those with and without type 2 diabetes mellitus (T2DM).
View Article and Find Full Text PDFEuropean System for Cardiac Operative Risk Evaluation II and Liver Dysfunction.
Biomedicines
January 2025
Cardiac Surgery, University of Medicine and Pharmacy "Gr. T. Popa", 700115 Iasi, Romania.
The importance of liver dysfunction in predicting mortality in patients undergoing cardiovascular surgery is an important topic due to the general desire to improve current risk scores such as EUROSCORE II (European System for Cardiac Operative Risk Evaluation), with EUROSCORE III being currently under development. The model for End-Stage Liver Disease (MELD) Score has already proven its utility in predicting outcomes for patients undergoing abdominal, cardiovascular or urological surgery. In the present study, we want to see its usefulness in proving the postoperative mortality in patients undergoing coronary artery bypass surgery.
View Article and Find Full Text PDFWant AI Summaries of new PubMed Abstracts delivered to your In-box?
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!