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Late outcome after coronary artery bypass graft surgery in patients < 40 years old
J K French1, D S Scott, R M Whitlock
1Department of Cardiology, Green Lane Hospital, Auckland, New Zealand.
Insights
Coronary artery bypass graft surgery (CABG) in patients under 40 shows long-term efficacy, but early recurrence of symptoms is possible. Optimal outcomes require internal mammary conduits, aspirin, lipid-modifying therapy, and diabetes management.
Area of Science:
- Cardiovascular Surgery
- Clinical Outcomes Research
Background:
- Randomized trials confirm long-term efficacy of coronary artery bypass graft surgery (CABG).
- Limited randomized data exists for CABG outcomes in patients younger than 40 years old.
- Patients under 40 undergoing CABG may experience early symptom recurrence.
Purpose of the Study:
- To examine the long-term postoperative outcome of CABG in patients younger than 40 years old.
- Identify factors influencing late mortality and recurrent ischemic events in this demographic.
Main Methods:
- Retrospective analysis of 221 patients under 40 who underwent CABG between 1970 and 1992.
- Assessment of 30-day mortality, median times to recurrent ischemic events, reintervention, and death.
- Statistical analysis (univariate and stepwise logistic regression) to identify predictors of adverse outcomes.
Main Results:
- The 30-day mortality was 1.8% for initial and 9.5% for redo CABG.
- Median times to recurrent ischemic events, reintervention, and death were 6.0, 9.6, and 14.2 years, respectively.
- Factors associated with increased late mortality included higher end-systolic volume, absence of internal mammary conduits, no lipid-modifying therapy, and no postoperative aspirin. Postoperative aspirin use was also linked to fewer recurrent ischemic events and reinterventions.
Conclusions:
- Patients under 40 requiring CABG should receive internal mammary conduits.
- Postoperative aspirin and lipid-modifying therapy are recommended to prevent recurrent ischemia and late death.
- Strict diabetes management and therapies to inhibit ventricular dilatation are crucial for optimal long-term outcomes in younger CABG patients.
Background:
Randomized trials confirm the long-term efficacy of coronary artery bypass graft surgery (CABG), although there are no randomized data in patients < 40 years old. Because these patients have been reported to have an early recurrence of symptoms, the long-term postoperative outcome was examined.
Methods And Results:
The long-term outcome of patients (n = 221) < 40 years old undergoing CABG at Green Lane Hospital, New Zealand, from 1970 to 1992 was determined. The 30-day mortality rate was 1.8% for initial and 9.5% for redo CABG. The median times to angina or myocardial infarction (recurrent ischemic event), further intervention, and death were 6.0, 9.6, and 14.2 years, respectively. Factors associated with increased late mortality on univariate analysis included end-systolic volume (ESV) > or = 80 mL (P = .004; 10-year mortality 19% versus 39% ESV > or = 80 mL), no internal mammary conduit (P = .01), no lipid-modifying therapy (P = .005), and no postoperative aspirin use (P = .0002); the latter was also associated with increased recurrent ischemic events (P = .04) or increased reintervention (P = .02). On stepwise logistic regression analysis, factors associated with increased late mortality were increasing ESV (P = .004), no internal mammary artery conduit (P = .009), diabetes (P = .04), and no postoperative aspirin (P = .02); the latter was also associated with increased recurrent ischemic events (P = .02). Hypercholesterolemia (> or = 6.5 mmol/L) was present in 65% of patients at presentation and 45% at follow-up.
Conclusions:
To attempt to prevent recurrent ischemia or late death, patients < 40 years old who require CABG should receive internal mammary conduits, aspirin, lipid-modifying therapy, therapy to inhibit ventricular dilatation, and strict diabetes management.