CORONARY REVASCULARIZATION IN YOUNG-ADULTS

Objective: To evaluate the long-term outcome of coronary artery bypass surgery (CABG) in patients < 40 years Id and to determine factors pre dictive of adverse outcomes. Methods: Retrospective review of data an 220 patients who underwent isolated CABG at Green Lane Hospital, New Z ealand from 1970 to 1992. Results: The actuarial survival after surger y was 91, 74 and 50% at 5: 10 and 15 years, respectively. Recurrence o f ischaemic symptoms occurred at a median time of 72 months, and only 20% of patients remained asymptomatic 10 years after CABG. Univariate analysis of potentially adverse surgical factors showed that patients who had prolonged bypass time (greater than or equal to 100 min, P < 0 .007) had increased late mortality. There were two distinct operative eras with respect to the use of IMA conduits (4% pre 1985, 87% post 19 84) The relationship between IMA conduits use and survival was signifi cant on time independent analysis (P < 0.02) but was not using the log -rank test. Preoperative clinical characteristics associated with incr eased late mortality were impaired left ventricular function (end-syst olic volume (ESV) greater than or equal to 80 mi, P = 0.008. ejection fraction < 40%, P = 0.0005), and lack of aspirin use either pre- or po st-operatively (P < 0.0001). Multivariate analysis indicated that redu ced ejection fraction (P = 0.04) and prolonged bypass time (P = 0.05) was associated with an increased risk of late death. Aspirin therapy ( P = 0.001) was associated with decreased late mortality. Cumulative ev ents rate of reintervention and mortality was reduced in female patien ts (P = 0.0009). At review, 45%) of patients had total cholesterol > 6 .5 mmol/l. Conclusion: To avoid the early recurrence of symptoms, the need for reintervention and late mortality, young patients should rece ive IMA conduits, cardisplegia as myocardial protection, aspirin and t herapy to modify/ameliorate their risk factors including dyslipidaemia , diabetes and left ventricular dysfunction. (C) 1997 Elsevier Science B.V.