title: Coronary artery bypass grafting in patients 50 years or younger: a Swedish nationwide cohort study.
abstract: BACKGROUND
  There are limited data regarding long-term results after coronary artery bypass grafting (CABG) in young adults. We performed a nationwide population-based cohort study to analyze long-term survival, major adverse cardiovascular events, and factors associated with elevated risk in young adults undergoing CABG.
  
  
  RESULTS
  We included all adult patients ≤50 years of age who underwent primary isolated CABG in Sweden between 1997 and 2013 from the Swedish Web System for Enhancement and Development of Evidence-Based Care in Heart Disease Evaluated According to Recommended Therapies (SWEDEHEART) register. Patient data were linked from national Swedish health data registers to create a study database. We identified 4086 young adults with a mean age of 46 years and 18% women. During a median follow-up time of 10.9 years (interquartile range, 6.4-14.1) 490 (12%) patients died. Survival at 5, 10, and 15 years was 96% (95% CI, 95-96), 90% (95% CI, 89-91), and 82% (95%CI, 80-83), respectively, which was significantly better in comparison with patients aged 51 to 70 years and >70 years who underwent CABG during the same period. The cumulative incidence of death or a major adverse cardiovascular event during 17 years after CABG was mainly driven by myocardial infarction or the need for repeat revascularization. The most important risk factors for all-cause mortality were chronic kidney disease, reduced left ventricular ejection fraction, peripheral vascular disease, or chronic obstructive pulmonary disease.
  
  
  CONCLUSIONS
  Long-term survival and freedom from major cardiovascular events after CABG was better in young adults than in older patients. Factors significantly associated with an elevated long-term risk of death or adverse outcome were similar to well-known risk factors for older age groups following CABG.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT02276950.
authors: From Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (M.D., T.I., U.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (M.D., T.I., U.S.); Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden (M.J.H.); and Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden (M.J.H.).
authors: Magnus
authors: M
authors: Dalén
authors: From Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (M.D., T.I., U.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (M.D., T.I., U.S.); Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden (M.J.H.); and Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden (M.J.H.).
authors: Torbjörn
authors: T
authors: Ivert
authors: From Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (M.D., T.I., U.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (M.D., T.I., U.S.); Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden (M.J.H.); and Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden (M.J.H.).
authors: Martin J
authors: MJ
authors: Holzmann
authors: From Department of Cardiothoracic Surgery and Anesthesiology, Karolinska University Hospital, Stockholm, Sweden (M.D., T.I., U.S.); Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden (M.D., T.I., U.S.); Department of Emergency Medicine, Karolinska University Hospital, Stockholm, Sweden (M.J.H.); and Department of Internal Medicine, Karolinska Institutet, Stockholm, Sweden (M.J.H.). Ulrik.Sartipy@karolinska.se.
authors: Ulrik
authors: U
authors: Sartipy
mesh_terms: D000328:Adult; D000367:Age Factors; D002318:Cardiovascular Diseases / Q000401:mortality; D015897:Comorbidity; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data*; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007674:Kidney Diseases / Q000401:mortality; D008297:Male; D011183:Postoperative Complications / Q000401:mortality; D016016:Proportional Hazards Models; D029424:Pulmonary Disease, Chronic Obstructive / Q000401:mortality; D012307:Risk Factors; D012959:Socioeconomic Factors; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology; D055815:Young Adult
keywords: cohort studies; coronary artery bypass; coronary artery disease; outcome assessment (health care); young adult