Late Outcome After Coronary Artery Bypass Graft Surgery in Patients <40 Years Old

Abstract

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) ≥80 mL ( P =.004; 10-year mortality 19% versus 39% ESV ≥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 (≥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.