Two decades of coronary artery bypass graft surgery in young adults

Between January 1970 and December 1991, 201 patients ≤40 years of age underwent coronary artery bypass graft surgery (CABG). Group 1 (1970 to 1980, n=119) and group 2 (1981 to 1991, n=82) corresponded to the eras before and after the onset of percutaneous transluminal coronary angioplasty (PTCA), respectively, and were analyzed for trends in patient profile, treatment, and risk factors for coronary 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 group 1 and 27% of group 2 (P=.048). Risk factor profile differed in the two groups: group 1 had more smokers (80%) than group 2 (68%) (P=.085), fewer patients with hypercholesterolemia (1, 37%; 2, 52%; P=.065), and significantly fewer diabetics (1, 10%; 2, 25%; P<.043). Mean preoperative New York Heart Association (NYHA) class was 3.2 in group 1 and 3.0 in group 2. The distributions of single-, double-, and triple-vessel CAD were similar in the groups. Preoperative myocardial infarction 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 group 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% and 70% in group 2 (P=.74). Twenty-year actuarial survival for the entire 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 group 2 continued to smoke. Among 22 patient- and treatment-related variables subjected to a Cox proportional-hazards multivariate regression analysis, the only significant predictors of late mortality were left main CAD and diabetes mellitus, and only diabetes and era of operation predicted intervention-free survival. This retrospective review of young 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 advent of PTCA.