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Thorac Cardiovasc Surg
DOI: 10.1055/s-0044-1789238
Original Cardiovascular

Long-term Survival in Elderly Patients after Coronary Artery Bypass Grafting Compared to the Age-matched General Population: A Meta-analysis of Reconstructed Time-to-Event Data

Hristo Kirov‡   *
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
,
Tulio Caldonazo‡   *
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
,
Sultonbek Toshmatov
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
,
Panagiotis Tasoudis
2   Division of Cardiothoracic Surgery, University of North Carolina, Chapel Hill, NC, United States
,
Murat Mukharyamov
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
,
Mahmoud Diab
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
,
Torsten Doenst
1   Department of Cardiothoracic Surgery, Friedrich-Schiller-University Jena, Jena, Germany
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Funding T.C. was funded by the Deutsche Forschungsgemeinschaft (DFG, German Research Foundation) Clinician Scientist Program OrganAge funding number 413668513, by the Deutsche Herzstiftung (DHS, German Heart Foundation) funding number S/03/2,3 and by the Interdisciplinary Center of Clinical Research of the Medical Faculty Jena. We acknowledge support from the German Research Foundation Project number 512648189 and the Open Access Publication Fund of the Thueringer Universitaets-und Landesbibliothek Jena.
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Abstract

Background Coronary artery disease (CAD) limits life expectancy compared to the general population. Myocardial infarctions (MIs) are the primary cause of death. The incidence of MI increases progressively with age and most MI deaths occur in the population older than 70 years. Coronary artery bypass grafting (CABG) may prevent the occurrence of new MIs by bypassing most CAD lesions, providing downstream “collateralization” to the diseased vessel, and consequently prolonging survival. We systematically assessed the survival-improving potential of CABG by comparing elderly CABG patients to the age-matched general population.

Methods Three databases were assessed. The primary and single outcome was long-term all-cause mortality. Time-to-event data of the individual studies were extracted and reconstructed in an overall survival curve. As a sensitivity analysis, summary hazard ratios (HRs) and 95% confidence intervals (CIs) for all individual studies were pooled and meta-analytically addressed. The control group was based on the age-matched general population of each individual study.

Results From 1,352 records, 4 studies (4,045 patients) were included in the analysis. Elderly patients (>70 years) who underwent CABG had a significantly lower risk of death in the follow-up compared to the general age-matched population in the overall survival analysis (HR: 0.88; 95% CI: 0.83, 0.94; p < 0.001: mean follow-up was 7 years).

Conclusion Elderly patients who undergo CABG appear to have significantly better long-term survival compared to the age-matched general population. This advantage becomes visible after the first year and underscores the life-prolonging effect of bypass surgery, which may eliminate the expected reduction in life expectancy through CAD.

Keywords

coronary artery bypass grafting - coronary artery disease - myocardial infarction - elderly patients

Data Availability Statement

The data underlying this article are available in the article and its online supplementary material.


Authors' Contribution

The modality of systematic review and meta-analysis involves different steps that need to be executed and coordinated collectively. Thus, H.K. and T.C. will share the first authorship due to the fact that they were directly involved not only in the design and statistical analysis of the study but also in the processes of study selection, determination of the level of bias, data extraction, and preparation of the manuscript.


* These authors contributed equally to this work.


Supplementary Material



Publikationsverlauf

Eingereicht: 12. Mai 2024

Angenommen: 29. Juli 2024

Artikel online veröffentlicht:
19. November 2024

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