Key result
CABG in octogenarians linked to ~22% lower long-term mortality than matched general population.
Why the study?
The study aimed to evaluate the risks and outcomes of coronary artery bypass grafting in patients aged 80 years and older in Australia.
What are the operative mortality and long-term survival outcomes of isolated coronary artery bypass surgery in octogenarians compared to younger patients and the general population?
Cohort (n=96,849)
Yes
What are the operative mortality and long-term survival outcomes of isolated coronary artery bypass surgery in octogenarians compared to younger patients and the general population?
Although octogenarians face higher operative mortality from CABG than younger patients, they achieve favorable long-term survival compared to the age- and sex-matched general population.
Octogenarians face higher CABG operative mortality; supports survival exceeding matched population norms but leaves open selection effects.
BACKGROUND: We aimed to evaluate the risks and outcomes of coronary artery bypass grafting in patients aged ≥80 years in Australia. METHOD: We conducted a retrospective cohort study of 96,849 patients who underwent isolated coronary artery bypass surgery between 1 January 2001 and 31 December 2022, using data from the Australian and New Zealand Society of Cardiac and Thoracic Surgeons cardiac surgery database. Patients were stratified into octogenarians and non-octogenarians. Primary outcomes included operative mortality (30-day or in-hospital death) and long-term survival. Kaplan-Meier estimates were used to analyse survival, logistic regression to identify predictors of early mortality, and Cox proportional hazards to identify predictors of late mortality. Survival in the octogenarian cohort was compared with an age- and sex-matched Australian population. RESULTS: Operative mortality was 2.8% in octogenarians vs 1.0% in non-octogenarians. The median follow-up was 3.4 years, with Kaplan-Meier estimated survival rates of 93%, 72%, 37% and 14% at 1, 5, 10, and 15 years. Median survival was 8.0 years in octogenarians, compared to 6.7 years in an age- and sex-matched general Australian population. The standardised mortality ratio was 0.78 (95% confidence interval 0.75-0.82; p<0.001). CONCLUSIONS: Although octogenarians undergoing coronary artery bypass have a higher operative risk than younger patients, mortality rates are lower than previously reported. Surgery in this population may be associated with favourable long-term survival compared to the general population. These findings support careful patient selection and shared decision-making when considering surgical revascularisation in the elderly.
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McNamara et al. (2026) conducted a cohort in Coronary artery disease (n=96,849). Coronary artery bypass grafting in octogenarians vs. Non-octogenarians and age- and sex-matched general population was evaluated on Operative mortality (30-day or in-hospital death) and long-term survival (SMR 0.78, 95% CI 0.75-0.82, p=<0.001). Coronary artery bypass grafting in octogenarians had 2.8% operative mortality vs 1.0% in younger patients, but better long-term survival than the general population (SMR 0.78; 95% CI 0.75-0.82).
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