Impact of incomplete revascularization in octagenary patients with multivessel disease

Aim: Quantify the extent of residual coronary disease after coronary bypass surgery (CABG) in very old patients (> 80) with multivessel disease and evaluate its impact on 1 year prognosis. Methods: Retrospective analysis from a single centre of 122 consecutive patients with ≥80 years of age undergoing isolated CABG between January 2005 and December 2010 (mean age 83±2; 63% men and 30% diabetics). We have identified 45 patients (37%) with complete revascularization (group A) and 77 patients (63%) with incomplete revascularization (group B). The baseline syntax score (SS), the residual syntax score after surgery (rSS) and the difference between the two syntax scores (Δ SS) were calculated. Kaplan Meier curves were used to compare the overall survival free from death and major cardiovascular events (MACCE: death, myocardial infarction, stroke and revascularization) at one year of follow-up. The area under the ROC curve (AUC) was used as a measure of discriminatory power of Syntax scores for MACCE and the test used to adjust the model was Hosmer-Lemeshow. Results: At one year follow-up (obtained in 96% of pts) freedom from primary composite end point was 79% (12,6% death, 9,0% myocardial infarction, 3,4% stroke and 0,8% revascularization). There were no differences in baseline clinical characteristics between the groups, which had similar surgical risk (median EuroSCORE II 3,91±2,8 vs 4,27±4,3; p=0,504). Group B patients showed a trend to higher rate of MACCE at 1 year (27,0 vs. 11,4; p=0,062), without differences in mortality (14,9 vs. 9,1; p=0,409). The subgroup analysis in the Kaplan-Meyer method revealed that MACCE was significantly lower in group A compared to group B (7,5% vs. 24,2% at 1 year, Log-rank p=0,033) and there was no difference in mortality between the two groups (5,0% vs. 12,1% at 1 year, Log-rank p=0,219). The SS and the ΔSS were not predictors of MACCE at 1 year (AUC: 0,51; 0,41-0,61; p=0,888; Hosmer Lemeshow: p=0,384) and (AUC: 0,56; 0,46-0,65; p0,406; Hosmer Lemeshow: p=0,904), respectively; the rSS showed a limited discriminatory power (AUC: 0,65; 0,55-0,74; p=0,049; Hosmer Lemeshow: p=0,292). Conclusions: The incomplete surgical revascularization in very old patients can be associated with more major cardiovascular events following. Further studies are needed to properly assess the impact of this strategy in this patient population.