Coronary revascularisation in young adults

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 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.