Comparison of Isolated Primary CABG in Two Successive Decades in Patients Under 40 Years of Age

Authors

  • Przemyslaw Trzeciak 3rd Department of Cardiology,Silesian Center for Heart Diseases, Zabrze
  • Marian Zembala Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze
  • Piotr Desperak 3rd Department of Cardiology,Silesian Center for Heart Diseases, Zabrze
  • Wojtek Karolak Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze
  • Michal Zembala Department of Cardiac Surgery and Transplantology, Silesian Center for Heart Diseases, Zabrze
  • Mariusz Gasior 3rd Department of Cardiology,Silesian Center for Heart Diseases, Zabrze

DOI:

https://doi.org/10.1532/hsf.1448

Abstract

Background: Coronary artery bypass graft (CABG) surgery is rarely performed in very young patients. The purpose of our study is to compare the characteristics, treatments, in-hospital, and long-term outcomes of two groups of patients less than 40 years of age who had CABG in two successive decades: 1990-2000 and 2001-2011.
Methods: We identified 145 consecutive patients who underwent primary isolated CABG. Group 1 consisted of
78 patients operated between 1990-2000 and group 2 consisted of 67 patients operated between 2001-2011. Composite end point assessed at follow-up period involved death or recurrence of symptoms, which we defined as myocardial infarction, a need for percutaneous coronary intervention (PCI), reoperation, or congestive heart failure (CHF).  
Results: Smoking and hypercholesterolemia before CABG were noted as more frequent in group 1 than in group 2: 96.1% versus 83.6%, P = .011; 88.5% versus 61.2%,
P = .0001, respectively. Patients from group 2 more frequently received one graft (29.8% versus 11.5%, P = .0059), were operated with off-pump (41.8% versus 0%, P < .0001) or MIDCAB (28.4% versus 0%, P = .0008) techniques, and had complete arterial revascularization (58.2% versus 23.1%, P < .0001). Group 1 patients had a higher prevalence of composite end point (33.9% versus 17.9%, P = .035), with no significant difference in mortality (11.5% versus 10.4%, P = .83).
Conclusion: Patients operated between 1990-2000 had a higher prevalence of smoking and hypercholesterolemia and higher frequency of composite-end point during folow-up period without significant difference in mortality.

References

Bandosz P, O’Flaherty M, Drygas W, et al. 2012. Decline in mortality from coronary heart disease in Poland after socioeconomic transformation: modelling study. BMJ 344:d8136.

Cohen DJ, Basamania C, Graeber GM, Deshong JL, Burge R. 1986. Coronary artery bypass grafting in young patients under 36 years of age. Chest 89:811-16.

Desai ND, Cohen EA, Naylor CD, et al. 2004. Radial Artery Patency Study Investigators. A Randomized comparison of radial-artery and saphenous-vein coronary bypass grafts. NEJM 351:2302-9.

Enos WF, Beyer JC, Holmes RH. 1955. Pathogenesis of coronary disease in american soldiers killed in Korea. JAMA 158:912-14.

Every NR, Maynard C, Cochran RP, Martin J, Weaver WD. 1996. Characteristics, management and outcome of patients with acute myocardial infarction treated with bypass surgery. Circulation 94(Suppl. II):II-81-6.

French JK, Scott DS, Whitlock RML, et al. 1995. Late outcome after coronary artery bypass graft surgery in patients < 40 years old. Circulation 92(suppl II): II-14-19.

Hurlé A, Bernabeu E, Gómez-Vicente R, Ventura J. 2008. Coronary bypass surgery in young adults. A long-term survey. Interact Cardiovasc Thorac Surg 7:126-9.

Karimi A, Ahmadi SH, Davoodi S, et al. 2007. Early outcome of coronary artery bypass grafting in patients less than 40 years old comparing with elderly patients. J Teh Univ Heart Ctr 2:95-9.

Kelly TF, Craver JM, Jones EL, Hatcher CR Jr. 1978. Coronary revascularization in patients 40 years and younger: surgical experience and long-term follow-up. Am Surg 44:675-8.

Kelly ME, De Laria GA, Najafi H. 1988. Coronary artery bypass surgery in patients less than 40 years of age. Chest 94:1138-41.

Laks H, Kaiser GC, Barner HB, Codd JE, Willman VI. 1978. Coronary revascularization under age 40 years. Am J Cardiol 41:584-9.

Nataf P, Parikh S, Rabago G, et al. 1992. Results of coronary artery surgery in young adults. J Cardiovasc Surg 33:281-4

Ng WK, Vedder M, Whitlock RM, et al. 1997. Coronary revascularisation in young adults. Eur J Card Thorac Surg 11:732-8.

Nguyen TD, de Virgilio C, Kakuda J, et al. 1998. Characteristics of patients less than 45 years of age compared with older patients undergoing coronary artery bypass grafting. Clin Cardiol 21:913-16.

Rohrer-Gubler I, Niederhauser U, Turina M. 1998. Late outcome of coronary artery bypass grafting in young versus older patients. Ann Thorac Surg 65:377-82.

Sajja LR, Mannam GC, Pantula NR, Ventura J. 2005. Reoperation for coronary artery disease in the young: early and mid-term results. Ind J Thorac Cardiovasc Surg 21: 199-203.

Samuels LE, Sharma S, Kaufman MS, Morris RJ, Brockman SK. 1996. Coronary artery bypass grafting in patients in their third decade of life. J Card Surg 11:402-7.

Widimsky P, Wijns W, Fajadet J, et al. 2010. European Association for Percutaneous Cardiovascular Interventions. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J 31:943-57.

Yater WM, Traum AH, Brown WG, Fitzgerald RP, Giesler MA, Wilcox BB. 1948. Coronary artery disease in men eighteen to thirty-nine years of age. Am Heart J 36: 334-72, 481-576, 683-772.

Zehr KJ, Lee PC, Poston RS, Gillinov AM, Greene PS, Cameron DE. 1994. Two decades of coronary artery bypass graft surgery in young adults. Circulation 90[part 2]:II-133-9.

Published

2016-06-24

How to Cite

Trzeciak, P., Zembala, M., Desperak, P., Karolak, W., Zembala, M., & Gasior, M. (2016). Comparison of Isolated Primary CABG in Two Successive Decades in Patients Under 40 Years of Age. The Heart Surgery Forum, 19(3), E139-E144. https://doi.org/10.1532/hsf.1448

Issue

Section

Article