Key result
In patients undergoing simultaneous CABG and carotid endarterectomy, age ≥70 years did not significantly increase 30-day mortality compared to younger patients (7.6% vs 2.3%, p=0.171), although 5-year survival was lower.
Why the study?
The study was conducted to investigate whether age impacts short- and long-term outcomes in patients undergoing simultaneous CABG and carotid endarterectomy.
Does age > 70 years worsen short and long-term outcomes in patients undergoing simultaneous CABG and carotid endarterectomy?
Cohort (n=186)
No
Does age > 70 years worsen short and long-term outcomes in patients undergoing simultaneous CABG and carotid endarterectomy?
Absolute Event Rate: 7.6% vs 2.3%
p-value: p=0.171
Simultaneous CABG and carotid endarterectomy can be performed with satisfactory short-term results in patients over 70, though 5-year survival is lower compared to younger patients.
Acceptable short-term mortality supports combined procedures in older patients; leaves open long-term survival implications for practice.
BACKGROUND: The purpose of this study was to investigate whether age has an effect on short and long-term outcome in patients who undergo simultaneous coronary artery bypass grafting (CABG) and carotid endarterectomy. METHODS: From 2005 to 2017, 186 consecutive elective patients underwent CABG and synchronous endarterectomy at our institution. Patients were retrospectively classified according to age into 2 groups: patients above 70 years (elderly group: n = 97, 76.1 ± 3.9 years) and patients below 70 years (younger group: n = 89, 63.2 ± 4.8 years). RESULTS: The European System for Cardiac Operative Risk Evaluation (EuroSCORE) II, 4.4% vs. 2.5%; p < 0.001) and Society of Thoracic Surgeons (STS) score (0.7% vs. 1.6%; p < 0.001) were significantly higher in the elderly group. Otherwise, there was no difference between the two groups concerning important preoperative risk factors or the intraoperative data. Postoperatively, the incidence of temporary dialysis was significantly higher in the elderly group (14.4% vs. 3.4%; p = 0.009). The rate of tracheotomy (16.5% vs. 2.2%; p = 0.001), of re-intubation (7.9% vs. 18.6%; p = 0.033) and drainage loss (600 ml vs. 800 ml; p = 0.035) was significantly higher in this elderly group. Neurological complications and 30-day mortality were comparable. Long-term survival was satisfactory for both groups. Nevertheless, 5-year survival rates (63% vs. 85%) were significantly lower in the elderly group (p = 0.003). Logistic regression analysis identified chronic obstructive pulmonary disease (COPD) and arrhythmia as significant risk factors for 30-day-mortality, but not age. CONCLUSIONS: CABG in combination with synchronous endarterectomy can also be performed with satisfactory results in elderly patients.
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Ravesh et al. (2019) conducted a cohort in Concomitant coronary artery disease and carotid artery stenosis (n=186). Age ≥ 70 years vs. Age < 70 years was evaluated on 30-day mortality (p=0.171). In patients undergoing simultaneous CABG and carotid endarterectomy, age ≥70 years did not significantly increase 30-day mortality compared to younger patients (7.6% vs 2.3%, p=0.171), although 5-year survival was lower.
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