title: Determinants of outcome after isolated coronary artery bypass grafting in patients aged ≤50 years (from the Coronary aRtery diseAse in younG adultS study).
abstract: This study was planned to identify the determinants of outcome after coronary artery bypass (CABG) in young patients. Data on 592 patients aged ≤50 years who underwent CABG from 9 European institutions were collected retrospectively. Twenty-eight percent of patients received at least 2 arterial grafts. Clopidogrel was used at discharge in 16.2% and statins in 67.2% of patients. Freedom from major adverse cardiac and cerebrovascular events at 1, 3, and 5 years was 93.8%, 90.1%, and 85.0%; survival rate was 98.3%, 96.3%, and 94.9%; freedom from myocardial infarction was 96.3%, 95.1%, and 92.5%; and freedom from repeat revascularization was 96.3%, 95.1%, and 92.5%, respectively. Neither types of grafts nor medication at discharge had any impact on the late outcome. Age <40 years (relative risk [RR] 2.19, 95% confidence interval [CI] 1.17 to 4.11), diabetes (RR 1.71, 95% CI 1.02 to 2.88), estimated glomerular filtration rate <60 ml/min/1.73 m(2) (RR 2.44, 95% CI 1.26 to 4.72), non-ST-elevation myocardial infarction/ST-elevation myocardial infarction (RR 2.12, 95% CI 1.27 to 3.55), emergency procedure (RR 2.34, 95% CI 1.13 to 4.88), and left ventricular ejection fraction <30% (RR 3.18, 95% CI 1.41 to 7.16) were independent predictors of major adverse cardiac and cerebrovascular events. Patients with left ventricular ejection fraction <30% had a particularly poor survival rate (at 5 years 67.7% vs 96.1%; adjusted analysis RR 14.01, 95% CI 5.16 to 38.03). Poor left ventricular function, myocardial infarction, diabetes, renal failure, and age <40 years are major determinants of late outcome after CABG in young patients. In conclusion, data from this real-world registry indicate that multiple arterial grafts and statin treatment are largely underutilized in these patients.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: fausto.biancari@ppshp.fi.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Jouni
authors.initials: J
authors.lastname: Heikkinen
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Vesa
authors.initials: V
authors.lastname: Anttila
authors.affiliation: Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Jeppsson
authors.affiliation: Cardiac Surgery Unit, Azienda Ospedaliera Universitaria. Policlinico-Vittorio Emanuele, University of Catania, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Mignosa
authors.affiliation: Cardiac Surgery Unit, Azienda Ospedaliera Universitaria. Policlinico-Vittorio Emanuele, University of Catania, Italy.
authors.forename: Antonino S
authors.initials: AS
authors.lastname: Rubino
authors.affiliation: Heart Center, Turku University Hospital, Turku, Finland.
authors.forename: Jarmo
authors.initials: J
authors.lastname: Gunn
authors.affiliation: Department of Anesthesiology, Vaasa Central Hospital, Vaasa, Finland.
authors.forename: Jan-Ola
authors.initials: JO
authors.lastname: Wistbacka
authors.affiliation: Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
authors.forename: Tomas A
authors.initials: TA
authors.lastname: Axelsson
authors.affiliation: Heart Center, Tampere University Hospital, Tampere, Finland.
authors.forename: Ari
authors.initials: A
authors.lastname: Mennander
authors.affiliation: Department of Cardiothoracic and Respiratory Sciences, Second University of Naples, c/o V. Monaldi Hospital, Naples, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: De Feo
authors.affiliation: Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
authors.forename: Tomas
authors.initials: T
authors.lastname: Gudbjartsson
authors.affiliation: Heart Center, Turku University Hospital, Turku, Finland.
authors.forename: Juhani
authors.initials: J
authors.lastname: Airaksinen
mesh_terms: D000328:Adult; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000503:physiopathology / Q000601:surgery*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome