LATE OUTCOME AFTER CORONARY-ARTERY BYPASS GRAFT-SURGERY IN PATIENTS LESS-THAN-40 YEARS OLD

Citation
Jk. French et al., LATE OUTCOME AFTER CORONARY-ARTERY BYPASS GRAFT-SURGERY IN PATIENTS LESS-THAN-40 YEARS OLD, Circulation, 92(9), 1995, pp. 14-19
Citations number
27
Language
INGLESE
art.tipo
Article
Categorie Soggetti
Cardiac & Cardiovascular System",Hematology
Journal title
Circulation → ACNP
ISSN journal
0009-7322
Volume
92
Issue
9
Year of publication
1995
Supplement
S
Pages
14 - 19
Database
ISI
SICI code
0009-7322(1995)92:9<14:LOACBG>2.0.ZU;2-Z
Abstract
Background Randomized trials confirm the long-term efficacy of coronar y artery bypass graft surgery (CABG), although there are no randomized data in patients <40 years old. Because these patients have been repo rted to have an early recurrence of symptoms, the long-term postoperat ive outcome was examined. Methods and Results The long-term outcome of patients (n=221) <40 years old undergoing CABG at Green Lane Hospital , New Zealand, from 1970 to 1992 was determined. The 30-day mortality rate was 1.8% for initial and 9.5% for redo CABG. The median times to angina or myocardial infarction (recurrent ischemic event), further in tervention, and death were 6.0: 9.6, and 14.2 years, respectively. Fac tors associated with increased late mortality on univariate analysis i ncluded end-systolic volume (ESV) greater than or equal to 80 mL (P=.0 04; 10-year mortality 19% versus 39% ESV greater than or equal to 80 m L), no internal mammary conduit (P=.01), no lipid-modifying therapy (P =.005), and no postoperative aspirin use (P=.0002); the latter was als o associated with increased recurrent ischemic events (P=.04) or incre ased reintervention (P=.02). On stepwise logistic regression analysis, factors associated with increased late mortality were increasing ESV (P=.004), no internal mammary artery conduit (P=.009), diabetes (P=.04 ), and no postoperative aspirin (P=.02); the latter was also associate d with increased recurrent ischemic events (P=.02). Hypercholesterolem ia (greater than or equal to 6.5 mmol/L) was present in 65% of patient s at presentation and 45% at follow-up. Conclusions To attempt to prev ent recurrent ischemia or late death, patients <40 years old who requi re CABG should receive internal mammary conduits, aspirin, lipid-modif ying therapy, therapy to inhibit ventricular dilatation, and strict di abetes management.