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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 108-115, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
JS Carey, RA Cukingnan and LK Singer
The effect of increasing age on quality of life, survival, and risk of
reoperation was studied in 2479 patients followed up prospectively 2 to 20
years after myocardial revascularization. Quality of life was determined
from annual questionnaires, which we used to calculate a health status
index from the patient's symptomatic status and subjective response to the
operation, which was graded between zero and 1.00 (asymptomatic). Four age
groups were studied: age 49 years or less (AG40), 50 to 59 years (AG50), 60
to 69 years (AG60), and 70 years or older (AG70). Associated problems (left
ventricular aneurysm, valve disease, acute myocardial infarction)
necessitating treatment were present in 17% (61/361) of AG40 patients, 19%
(165 of 859) of AG50 patients, 23% (213/927) of AG60 patients, and 31%
(102/332) of AG70 patients. The hospital mortality rate was higher in older
patients undergoing combined procedures but not in patients undergoing
coronary bypass grafts only. Probability of survival and health status
indexes were calculated excluding patients with valve disease and
cardiogenic shock. Probability of survival was significantly better (p less
than 0.001 by the Wilcoxon test) in patients less than age 60 than in those
60 years or older, but in patients with an ejection fraction greater than
or equal to 0.40, probability of survival at 12 years was 0.64 (age less
than 60) versus 0.62 (age greater than or equal to 60). The actuarial risk
of reoperation, calculated as the difference between probability of
survival and probability of survival without reoperation, progressively
increased in younger patients but not in patients aged 60 years or older.
At 15 years, the reoperation rates were 26% (AG40), 14% (AG50), 5% (AG60),
and 7% (AG70). Mean health status index for years 1 to 5 was 0.85 in AG40
patients, 0.84 in AG50 patients, 0.89 in AG60 patients, and 0.90 in AG70
patients; for years 6 to 10, 0.81, 0.80, 0.86, and 0.89; and for years 11
to 15, 0.77, 0.78, 0.84, and 0.84, respectively. Thus quality of life after
myocardial revascularization is better, improvement lasts longer, and
reoperation rate is less in patients aged 60 years or older.
ARTICLES
Quality of life after myocardial revascularization. Effect of increasing age
Department of Surgery, Torrance Memorial Medical Center, Calif.
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