Impacto da idade nos desfechos precoces da cirurgia de revascularização miocárdica

Abstract

Background: Coronary Artery Bypass Grafting (CABG) surgery is one of the main treatment options for coronary artery disease (CAD), but some studies suggest that advanced age might be an isolated risk factor for unfavorable outcomes in these surgeries. Objectives: To evaluate the impact of age on the main postoperative outcomes of coronary artery bypass grafting (CABG) surgery, regarding risk factors associated with mortality, hospital mortality, and postoperative complications. Methods: Retrospective observational cohort study conducted at Hospital São Lucas of PUCRS. We included patients who underwent isolated CABG, from January 1996 to January 2023. Patients were divided into 3 groups according to geriatric age groups of interest: group 1: 18-59 yo; group 2: 60-79 yo; and group 3: 80 yo or older. We analyzed the preoperative characteristics and surgical technical variables from the patients' profile. The evaluated variables included clinical complications, need for reoperation, mediastinitis, duration of stay in the intensive care unit (ICU), and duration of hospital stay. Results: Out of 5,327 patients undergoing CABG, 3,135 participants were from group 2 (58.85%). Group 1 participants showed a higher frequency of smoking (42.5% p<0.001), NYHA class 1 heart failure (68.5% p<0.001), and previous cardiac surgery (2.7% p=0.566). Group 2 had a higher frequency of diabetes (36.7% p<0.001), hypertension (78.6% p<0.001), previous stroke (8.6% p=0.001), class 1 angina (6.4%), and asymptomatic cases (21.5% p=0.023), and a lower mean ejection fraction (53.97 ± 14.84 p=0.353). Group 3 showed a higher frequency of chronic kidney disease (26.3% p<0.001), atrial fibrillation (9.4% p<0.001), dyslipidemia (28.1% p=0.596), NYHA classes II (21.5%), III (17.1%), IV (7%) (p<0.001), class 3 angina (25% p=0.023), and higher ejection fraction with a mean of 55.77 ± 14.46% p=0.353). The percentage of mammary artery use was higher in group 1 (79.5%). The number of saphenous veins (2.5 ± 1; p<0.001), cardiopulmonary bypass time (92.79 ± 34.73; p<0.001), and aortic cross-clamp time (56.08 ± 26.01; p=0.012) were higher in group 3. Mediastinitis was more prevalent in group 2 (3.1%). The percentages of myocardial infarction (14.4%; p=0.856), stroke (7.5%; p<0.001), reoperation (8.1%; p<0.001), ICU stay (6.91 ± 8.66; p<0.001), and hospital stay (21.96 ± 12.5; p<0.001) were higher in group 3. There was equivalence in mortality regarding the location of death, and mortality rates did not differ between age groups (p=0.670). Conclusion: There was no difference of mortality among the three groups of patients undergoing CABG. Long-lived elderly individuals showed a higher incidence of comorbidities such as CKD and AF. A higher proportion of postoperative complications was identified in this group, such as stroke, need for surgical re-intervention, as well as a longer stay in the intensive care unit (ICU) and in the hospital.