title: Comparison of 30-day and 5-year outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in patients aged≤50 years (the Coronary aRtery diseAse in younG adultS Study).
abstract: Data on the outcome of young patients after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are scarce. Data on 2,209 consecutive patients aged≤50 years who underwent CABG or PCI were retrospectively collected from 15 European institutions. PCI and CABG had similar 30-day mortality rates (0.8% vs 1.4%, p=0.27), late survival (at 5 years, 97.8% vs 94.9%, p=0.082), and freedom from stroke (at 5 years, 98.0% and 98.0%, p=0.731). PCI was associated with significantly lower freedom from major adverse cardiac and cerebrovascular events (at 5 years, 73.9% vs 85.0%, p<0.0001), repeat revascularization (at 5 years, 77.6% vs 92.5%, p<0.0001), and myocardial infarction (at 5 years, 89.9% vs 96.6%, p<0.0001) compared with CABG. These findings were confirmed in propensity score-adjusted and matched analyses. Freedom from major adverse cardiac and cerebrovascular events after PCI was particularly low in diabetics (at 5 years, 58.0% vs 75.9%, p<0.0001) and in patients with multivessel disease (at 5 years, 63.6% vs 85.1%, p<0.0001). PCI in patients with ST elevation myocardial infarction was associated with significantly better 5-year survival (97.5% vs 88.8%, p=0.001), which was driven by its lower 30-day mortality rate (1.5% vs 6.0%, p=0.017). In conclusion, patients aged≤50 years have an excellent immediate outcome after either PCI or CABG with similar long-term survival when used according to the current clinical practice. PCI was associated with significantly lower freedom from myocardial infarction and repeat revascularization.
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: faustobiancari@yahoo.it.
authors.forename: Fausto
authors.initials: F
authors.lastname: Biancari
authors.affiliation: Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavík, Iceland.
authors.forename: Tomas
authors.initials: T
authors.lastname: Gudbjartsson
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 Internal Medicine, Oulu University Hospital, Oulu, Finland.
authors.forename: Timo
authors.initials: T
authors.lastname: Mäkikallio
authors.affiliation: Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Jeppsson
authors.affiliation: Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
authors.forename: Linda
authors.initials: L
authors.lastname: Thimour-Bergström
authors.affiliation: Cardiac Surgery Unit, Azienda Ospedaliero Universitaria (A.O.U.) Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
authors.forename: Carmelo
authors.initials: C
authors.lastname: Mignosa
authors.affiliation: Cardiac Surgery Unit, Azienda Ospedaliero Universitaria (A.O.U.) Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
authors.forename: Antonino S
authors.initials: AS
authors.lastname: Rubino
authors.affiliation: Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Kuttila
authors.affiliation: Heart Center, Turku University Hospital and University of Turku, 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 Surgery, Vaasa Central Hospital, Vaasa, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Teittinen
authors.affiliation: Department of Internal Medicine, Vaasa Central Hospital, Vaasa, Finland.
authors.forename: Kari
authors.initials: K
authors.lastname: Korpilahti
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Onorati
authors.affiliation: Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Faggian
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona Medical School, Verona, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Vinco
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona Medical School, Verona, Italy.
authors.forename: Corrado
authors.initials: C
authors.lastname: Vassanelli
authors.affiliation: Division of Cardiology, Department of Medicine, University of Verona Medical School, Verona, Italy.
authors.forename: Flavio
authors.initials: F
authors.lastname: Ribichini
authors.affiliation: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors.forename: Tatu
authors.initials: T
authors.lastname: Juvonen
authors.affiliation: Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavík, Iceland.
authors.forename: Tomas A
authors.initials: TA
authors.lastname: Axelsson
authors.affiliation: Department of Cardiology, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
authors.forename: Axel F
authors.initials: AF
authors.lastname: Sigurdsson
authors.affiliation: Heart Center, Satakunta Central Hospital, Pori, Finland.
authors.forename: Pasi P
authors.initials: PP
authors.lastname: Karjalainen
authors.affiliation: Heart Center, Tampere University Hospital, Tampere, Finland.
authors.forename: Ari
authors.initials: A
authors.lastname: Mennander
authors.affiliation: Heart Center, Tampere University Hospital, Tampere, Finland.
authors.forename: Olli
authors.initials: O
authors.lastname: Kajander
authors.affiliation: Heart Center, Tampere University Hospital, Tampere, Finland.
authors.forename: Markku
authors.initials: M
authors.lastname: Eskola
authors.affiliation: Heart Center, Tampere University Hospital, Tampere, Finland.
authors.forename: Erkki
authors.initials: E
authors.lastname: Ilveskoski
authors.affiliation: Department of Cardiothoracic and Respiratory Sciences, V. Monaldi Hospital, Naples, Italy.
authors.forename: Veronica
authors.initials: V
authors.lastname: D'Oria
authors.affiliation: Department of Cardiothoracic and Respiratory Sciences, V. Monaldi Hospital, Naples, Italy.
authors.forename: Marisa
authors.initials: M
authors.lastname: De Feo
authors.affiliation: Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
authors.forename: Tuomas
authors.initials: T
authors.lastname: Kiviniemi
authors.affiliation: Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
authors.forename: K E Juhani
authors.initials: KE
authors.lastname: Airaksinen
mesh_terms: D000328:Adult; D017677:Age Distribution; D000367:Age Factors; D001026:Coronary Artery Bypass / Q000379:methods*; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005060:Europe / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000379:methods*; D011184:Postoperative Period; D057216:Propensity Score; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D016896:Treatment Outcome