2 DECADES OF CORONARY-ARTERY BYPASS GRAFT-SURGERY IN YOUNG-ADULTS

Between January 1970 and December 1991, 201 patients less than or equa l to 40 years of age underwent coronary artery bypass graft surgery (C ABG). Group 1 (1970 to 1980, n=119) and group 2 (1981 to 1991, n=82) c orresponded to the eras before and after the onset of percutaneous tra nsluminal coronary angioplasty (PTCA), respectively, and were analyzed for trends in patient profile, treatment, and risk factors for corona ry artery disease (CAD): smoking, hypertension, hypercholesterolemia, diabetes, and family history. Mean age at operation was similar in the groups (1, 37+/-3.4 years; 2, 36+/-3.1 years). Women made up 18% of g roup 1 and 27% of group 2 (P=.048). Risk factor profile differed in th e two groups: group 1 had more smokers (80%) than group 2 (68%) (P=.08 5), fewer patients with hypercholesterolemia (1, 37%; 2, 52%; P=.065), and significantly fewer diabetics (1, 10%; 2, 25%; P<.043). Mean preo perative New York Heart Association (NYHA) class was 3.2 in group 1 an d 3.0 in group 2. The distributions of single-, double-, and triple-ve ssel CAD were similar in the groups. Preoperative myocardial infarctio n occurred in 55% of group 1 versus 61% in group 2 (P=NS). No group 1 patient received PTCA before CABG, but PTCA was performed in 15 group 2 patients. Left internal mammary artery grafts were used in 4% of gro up 1 and 57% of group 2 patients. CABG operative mortality was 7.0% in group 1 and 1.2% in group 2. Actuarial survivals 5 and 10 years after CABG were similar in the groups: 86% and 77% in group 1 versus 91% an d 70% in group 2 (P=.74). Twenty-year actuarial survival for the entir e series was 40%. Late NYHA class was 1.8+/-1.1 in group 1 and 1.55+/- 0.94 in group 2 (P=NS). Fifty-two percent of group 1 and 64% of group 2 returned to work. Forty percent of group 1 smokers and 36.5% of grou p 2 continued to smoke. Among 22 patient- and treatment-related variab les subjected to a Cox proportional-hazards multivariate regression an alysis, the only significant predictors of late mortality were left ma in CAD and diabetes mellitus, and only diabetes and era of operation p redicted intervention-free survival. This retrospective review of youn g CABG patients demonstrates that (1) 10-year survival after CABG has not changed over the past 20 years, (2) the proportion of young women undergoing CABG is increasing, (3) diabetes is increasingly prevalent, and (4) severity of CAD and LV dysfunction is unchanged despite the a dvent of PTCA.