ABSTRACT
The prevalence of coronary artery disease (CAD) increases with age, and older patients tend to have more severe CAD, including multivessel disease and left main disease, compared to younger patients. In addition, as the population ages, the number of older adults with clinically significant CAD will continue to rise. Over the past 20 years, morbidity and mortality associated with coronary artery bypass grafting (CABG) in older adults, including those over 80 years of age, has declined progressively due to improved surgical techniques and perioperative care. Moreover, among older adults with severe CAD, CABG provides equivalent or, in many situations, superior long-term outcomes compared to percutaneous coronary intervention (PCI) or optimal medical therapy. Conversely, the rate of nonfatal perioperative complications, including stroke, cognitive dysfunction, renal insufficiency, and pulmonary disorders, is higher in elderly patients undergoing CABG compared to younger patients. Very elderly patients with severe left ventricular dysfunction, poor functional status, frailty, dementia, or multiple comorbid conditions may not be suitable candidates for CABG. Thus, treatment for CAD in older patients must be individualized, but CABG remains a highly effective therapy for improving quality of life (QOL) and extending functional survival and should be offered to appropriately selected elderly patients with advanced CAD.
