RSS-Feed abonnieren
DOI: 10.1055/s-0041-1736229
Prognosis and Clinical Results after Coronary Artery Bypass Operation in Young Patients Aged <45 Years: Chances and Limitations of a New Therapy Option
Funding This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.![](https://www.thieme-connect.de/media/thoracic/202207/lookinside/thumbnails/10-1055-s-0041-1736229_216271oc-1.jpg)
Abstract
Coronary artery bypass grafting (CABG) is the recommended type of revascularization procedure in patients with left main or three-vessel disease and is considered an alternative when percutaneous coronary intervention is not feasible. We evaluated registry data to obtain long-term outcome data.
All patients ≤45 years in whom CABG was performed between 2009 and 2019 were selected from the Heart and Diabetes Center NRW, Germany. Cox regression analysis was applied to estimate the incidence risk of events after surgery.
A total of 209 patients (81.8% male) were included. Mean (standard deviation) follow-up duration was 5.8 (3.1) years. The combined outcome of death, stroke, myocardial infarction, or repeated revascularization occurred in 31 patients (14.8%). Estimated mean time to event was 8.5 (standard error: 0.22) years. By the end of the follow-up period, 8 patients (3.8%) had died, among whom 2 (1.0%) died within 1 month after surgery, 1 (0.5%) within 1 year, 1 (0.5%) within 2 years, and 4 (1.9%) after 2 years.
Risk factors independently associated with postsurgery events were angina pectoris CCS (Canadian Cardiovascular Society) class IV (adjusted hazard ratio [HR]: 4.954; 95% confidence interval [CI]: 1.322–18.563; p = 0.018) and STS (Society of Thoracic Surgeons) score (adjusted HR: 1.152 per scoring point; 95% CI: 1.040–1.276; p = 0.007).
After performing CABG in patients ≤45 years, event-free long-term outcomes were observed in the majority of patients. Presence of angina pectoris CCS class IV and higher STS scores were independently associated with adverse postsurgery events.
* Dr Thomas Wittlinger takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.
Publikationsverlauf
Eingereicht: 22. April 2021
Angenommen: 13. Juli 2021
Artikel online veröffentlicht:
22. November 2021
© 2021. Thieme. All rights reserved.
Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany
-
References
- 1 Dasari TW, Hamilton S, Chen AY. et al. Non-eligibility for reperfusion therapy in patients presenting with ST-segment elevation myocardial infarction: Contemporary insights from the National Cardiovascular Data Registry (NCDR). Am Heart J 2016; 172: 1-8
- 2 Ranasinghe I, Alprandi-Costa B, Chow V. et al. Risk stratification in the setting of non-ST elevation acute coronary syndromes 1999-2007. Am J Cardiol 2011; 108 (05) 617-624
- 3 Shahian DM, O'Brien SM, Normand SL, Peterson ED, Edwards FH. Association of hospital coronary artery bypass volume with processes of care, mortality, morbidity, and the Society of Thoracic Surgeons composite quality score. J Thorac Cardiovasc Surg 2010; 139 (02) 273-282
- 4 Cole JH, Miller III JI, Sperling LS, Weintraub WS. Long-term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol 2003; 41 (04) 521-528
- 5 D'Errigo P, Biancari F, Maraschini A, Rosato S, Badoni G, Seccareccia F. Thirty-day mortality after coronary artery bypass surgery in patients aged <50 years: results of a multicenter study and meta-analysis of the literature. J Card Surg 2013; 28 (03) 207-211
- 6 Börgermann J, Hakim K, Renner A. et al. Clampless off-pump versus conventional coronary artery revascularization: a propensity score analysis of 788 patients. Circulation 2012; 126 (11, Suppl 1): S176-S182
- 7 Furukawa N, Kuss O, Preindl K. et al. Anaortic off-pump versus clampless off-pump using the PAS-Port device versus conventional coronary artery bypass grafting: mid-term results from a matched propensity score analysis of 5422 unselected patients. Eur J Cardiothorac Surg 2017; 52 (04) 760-767
- 8 Biancari F, Onorati F, Faggian G. et al. Determinants of outcome after isolated coronary artery bypass grafting in patients aged ≤50 years (from the Coronary aRtery diseAse in younG adultS study). Am J Cardiol 2014; 113 (02) 275-278
- 9 Parikh SV, de Lemos JA, Jessen ME. et al; CRUSADE and ACTION Registry-GWTG Participants. Timing of in-hospital coronary artery bypass graft surgery for non-ST-segment elevation myocardial infarction patients results from the National Cardiovascular Data Registry ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines). JACC Cardiovasc Interv 2010; 3 (04) 419-427
- 10 French JK, Scott DS, Whitlock RM. et al. Late outcome after coronary artery bypass graft surgery in patients < 40 years old. Circulation 1995; 92 (9, Suppl): II14-II19
- 11 Saraiva J, Antunes PE, Antunes MJ. Coronary artery bypass surgery in young adults: excellent perioperative results and long-term survival. Interact Cardiovasc Thorac Surg 2017; 24 (05) 691-695
- 12 Dalén M, Ivert T, Holzmann MJ, Sartipy U. Coronary artery bypass grafting in patients 50 years or younger: a Swedish nationwide cohort study. Circulation 2015; 131 (20) 1748-1754
- 13 Trzeciak P, Karolak W, Gąsior M, Zembala M. In-hospital and long-term outcomes of coronary artery bypass graft surgery in patients ≤ 45 years of age and older (from the KROK registry). Kardiol Pol 2017; 75 (09) 884-892
- 14 Mohr FW, Morice MC, Kappetein AP. et al. Coronary artery bypass graft surgery versus percutaneous coronary intervention in patients with three-vessel disease and left main coronary disease: 5-year follow-up of the randomised, clinical SYNTAX trial. Lancet 2013; 381 (9867): 629-638
- 15 Serruys PW, Morice MC, Kappetein AP. et al; SYNTAX Investigators. Percutaneous coronary intervention versus coronary-artery bypass grafting for severe coronary artery disease. N Engl J Med 2009; 360 (10) 961-972
- 16 Davierwala PM, Leontyev S, Verevkin A. et al. Temporal trends in predictors of early and late mortality after emergency coronary artery bypass grafting for cardiogenic shock complicating acute myocardial infarction. Circulation 2016; 134 (17) 1224-1237
- 17 Leviner DB, Witberg G, Sharon A. et al. Long-term outcomes of contemporary coronary revascularization by percutaneous coronary intervention or coronary artery bypass grafting in young adults. Isr Med Assoc J 2019; 21 (12) 817-822
- 18 Fukui T, Tabata M, Morita S, Takanashi S. Early and long-term outcomes of coronary artery bypass grafting in patients with acute coronary syndrome versus stable angina pectoris. J Thorac Cardiovasc Surg 2013; 145 (06) 1577-1583 , 1583.e1
- 19 Schiller W. Risiko-scores in der Erwachsenen-Herz-Chirurgie. Zeitschrift für Herz- Thorax- und Gefäßchirurgie 2014; 4: 1-6
- 20 Sabik III JF, Blackstone EH, Gillinov AM, Banbury MK, Smedira NG, Lytle BW. Influence of patient characteristics and arterial grafts on freedom from coronary reoperation. J Thorac Cardiovasc Surg 2006; 131 (01) 90-98
- 21 Dimitrova KR, Hoffman DM, Geller CM, Dincheva G, Ko W, Tranbaugh RF. Arterial grafts protect the native coronary vessels from atherosclerotic disease progression. Ann Thorac Surg 2012; 94 (02) 475-481
- 22 Neumann FJ, Sousa-Uva M, Ahlsson A. et al; ESC Scientific Document Group. 2018 ESC/EACTS guidelines on myocardial revascularization. Eur Heart J 2019; 40 (02) 87-165
- 23 Rosato S, Biancari F, D'Errigo P, Fusco D, Seccareccia F. Midterm outcome of coronary artery bypass grafting in young patients: a multicenter italian study. Ann Thorac Surg 2015; 100 (05) 1689-1696
- 24 Mauri L, Kereiakes DJ, Yeh RW. et al; DAPT Study Investigators. Twelve or 30 months of dual antiplatelet therapy after drug-eluting stents. N Engl J Med 2014; 371 (23) 2155-2166
- 25 Udell JA, Bonaca MP, Collet JP. et al. Long-term dual antiplatelet therapy for secondary prevention of cardiovascular events in the subgroup of patients with previous myocardial infarction: a collaborative meta-analysis of randomized trials. Eur Heart J 2016; 37 (04) 390-399