Coronary revascularisation in young adults

• Published in: European journal of cardio-thoracic surgery Vol. 11; no. 4; pp. 732 - 738
• Main Authors: WAI KIAT NG, VEDDER, M, WHITLOCK, R. M. L, MILSOM, F. P, NISBET, H. D, SMITH, W. M, KERR, A. R, FRENCH, J. K
• Format: Journal Article
• Language: English
• Published: Amsterdam Elsevier Science B.V 01-04-1997; Elsevier Science
• Subjects: Actuarial Analysis; Adult; Biological and medical sciences; Cardiology. Vascular system; Cause of Death; Coronary Artery Bypass; Coronary Disease - mortality; Coronary Disease - surgery; Coronary heart disease; Female; Follow-Up Studies; Heart; Humans; Hypothermia, Induced; Internal Mammary-Coronary Artery Anastomosis; Male; Medical sciences; Postoperative Complications - etiology; Postoperative Complications - mortality; Postoperative Complications - surgery; Reoperation; Retrospective Studies; Risk Factors; Survival Analysis; Treatment Outcome; Human; Relapse; Mortality; Cardiovascular disease; Coronary heart disease; Long term; Result; Treatment; Aortocoronary; Bypass; Surgery; Young adult; Risk factor
• ISSN: 1010-7940; 1873-734X
• DOI: 10.1016/S1010-7940(97)01153-6

OBJECTIVE: To evaluate the long-term outcome of coronary artery bypasssurgery (CABG) in patients < 40 years old and to determine factorspredictive of adverse outcomes. METHODS: Retrospective review of data on220 patients who underwent isolated CABG at Green Lane Hospital, NewZealand from 1970 to 1992. RESULTS: The actuarial survival after surgerywas 91, 74 and 50% at 5, 10 and 15 years, respectively. Recurrence ofischaemic symptoms occurred at a median time of 72 months, and only 20% ofpatients remained asymptomatic 10 years after CABG. Univariate analysis ofpotentially adverse surgical factors showed that patients who had prolongedbypass time (> or = 100 min, P < 0.007) had increased late mortality.There were two distinct operative eras with respect to the use of IMAconduits (4% pre 1985, 87% post 1984) The relationship between IMA conduitsuse and survival was significant on time independent analysis (P <0.02), but was not using the log-rank test. Preoperative clinicalcharacteristics associated with increased late mortality were impaired leftventricular function (end-systolic volume (ESV) > or = 80 ml, P = 0.008;ejection fraction < 40%, P = 0.0005), and lack of aspirin use eitherpre- or post- operatively (P < 0.0001). Multivariate analysis indicatedthat reduced ejection fraction (P = 0.04) and prolonged bypass time (P =0.05) was associated with an increased risk of late death. Aspirin therapy(P = 0.001) was associated with decreased late mortality. Cumulative eventsrate of reintervention and mortality was reduced in female patients (P =0.0009). At review, 45% of patients had total cholesterol > 6.5 mmol/l.CONCLUSION: To avoid the early recurrence of symptoms, the need forreintervention and late mortality, young patients should receive IMAconduits, cardioplegia as myocardial protection, aspirin and therapy tomodify/ameliorate their risk factors including dyslipidaemia, diabetes andleft ventricular dysfunction.