Coronary Artery Disease in Young Adults: Who Needs Surgical Revascularization? A Retrospective Cohort Study
Jacek Piątek1,2, Anna Kędziora3, Janusz Konstanty-Kalandyk1,2
1Institute of Cardiology and Department of Cardiovascular Surgery and Transplantology, John Paul II Hospital, Krakow, Poland.
Insights
Coronary artery disease (CAD) in young adults undergoing coronary artery bypass grafting (CABG) often involves multivessel disease. While outcomes are generally good, a high rate of emergent surgeries highlights the need for early CAD screening in younger populations.
Area of Science:
- Cardiology
- Cardiovascular Surgery
- Public Health
Background:
- Coronary artery disease (CAD) is a leading cause of mortality and morbidity.
- An increasing incidence of CAD is observed in younger populations globally.
- This study focuses on young adults (≤50 years) with CAD requiring coronary artery bypass grafting (CABG).
Purpose of the Study:
- To characterize the demographic and clinical profile of young adults undergoing CABG.
- To evaluate early postoperative outcomes and complications in this patient cohort.
- To identify factors associated with adverse outcomes after CABG in young patients.
Main Methods:
- Retrospective cohort study of 190 patients aged ≤50 years undergoing CABG (2010-2014).
- Analysis of baseline characteristics, operative data, and postoperative complications.
- Assessment included major adverse cardiac and cardiovascular events (MACCE), prolonged ventilation, bleeding, and sternal dehiscence.
Main Results:
- The study cohort comprised predominantly overweight/obese males (mean age 46 ± 4.1 years).
- Most patients had three-vessel disease (81%), hypertension (74.7%), and prior myocardial infarction (60%), with normal left ventricle ejection fraction (LVEF) in 83.1%.
- Emergent procedures (22.6%) were linked to higher complication rates (P = .007); perioperative mortality was 1% and MACCE was 2.6%.
Conclusions:
- CAD in young patients presents with significant multivessel disease and often normal LVEF.
- Despite low complication rates, a high percentage of emergent surgeries underscores insufficient early detection.
- Early screening for CAD in younger individuals is crucial for timely therapeutic intervention or elective surgery.
Background:
Coronary artery disease (CAD) is a major cause of death and disability in developed countries. Despite the fact that prevalence accrues with age, an increasing number of young patients suffering from CAD is being observed worldwide. The aim of this study is to describe the population of young adults suffering from CAD and requiring coronary artery bypass grafting (CABG), and to assess early outcomes after the procedure.
Methods:
A retrospective cohort study analyzed 190 consecutive patients aged ≤50 years old that underwent CABG between 2010 and 2014. Baseline characteristics and operative data were presented in the study. Postoperative complications, such as major adverse cardiac and cardiovascular events (MACCE), prolonged mechanical ventilation (>72 hours), bleeding requiring reexploration, sternal dehiscence, and others were assessed.
Results:
A population comprising mostly overweight or obese males with a mean age of 46 ± 4.1 years was analyzed. Patients suffered mostly from three-vessel disease (81%), hypertension (74.7%), and had previous history of myocardial infarction (MI) (60%). The majority of patients had normal left ventricle ejection fraction (LVEF) (83.1%). 22.6% of cases were emergent procedures. Perioperative mortality was low (1%) and overall MACCE rate stood at 2.6%. Emergent surgery was associated with a higher incidence of postoperative complications (P = .007). The number of diseased vessels, LVEF, and CCS/NYHA class-on-admission was not associated with a higher incidence of postoperative complications (P > .05 for all).
Conclusion:
CAD in young patients remains an issue described insufficiently in the literature. Among our study cohort of younger patients undergoing CABG, the majority of the patients had multivessel disease and were slightly symptomatic with normal LVEF. Although the postoperative complication rate was low, the percentage of emergent surgeries was alarmingly high in this population. Consistent with the literature, we highlight the importance of CAD screening in the young population to detect subclinical disease, which might be treated therapeutically or operated electively.
