Determinants of Outcome After Isolated Coronary Artery Bypass Grafting in Patients Aged 鈮?0聽Years (from the Coronary aRtery diseAse in younG adultS Study)
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- 作者：Fausto Biancari ; Francesco Onorati ; Giuseppe Faggian ; Jouni Heikkinen ; Vesa Anttila ; Anders Jeppsson ; Carmelo Mignosa ; Antonino S. Rubino ; Jarmo Gunn ; Jan-Ola Wistbacka ; Tomas A. Axelsson ; Ari Menn ; er ; Marisa De Feo ; Tomas Gudbjartsson ; Juhani Airaksinen
- 刊名：The American Journal of Cardiology
- 出版年：15 January, 2014
- 年：2014
- 卷：113
- 期：2
- 页码：275-278
- 全文大小：222 K
文摘
This study was planned to identify the determinants of outcome after coronary artery bypass (CABG) in young patients. Data on 592 patients aged 鈮?0聽years who underwent CABG from 9聽European institutions were collected retrospectively. Twenty-eight percent of patients received at least 2 arterial grafts. Clopidogrel was used at discharge in 16.2% and statins in 67.2% of patients. Freedom from major adverse cardiac and cerebrovascular events at 1, 3, and 5聽years was 93.8%, 90.1%, and 85.0%; survival rate was 98.3%, 96.3%, and 94.9%; freedom from myocardial infarction was 96.3%, 95.1%, and 92.5%; and freedom from repeat revascularization was 96.3%, 95.1%, and 92.5%, respectively. Neither types of grafts nor medication at discharge had any impact on the late outcome. Age <40聽years (relative risk [RR] 2.19, 95% confidence interval [CI] 1.17 to 4.11), diabetes (RR 1.71, 95% CI 1.02 to 2.88), estimated glomerular filtration rate <60聽ml/min/1.73聽m2 (RR 2.44, 95% CI 1.26 to 4.72), non-ST-elevation myocardial infarction/ST-elevation myocardial infarction (RR 2.12, 95% CI 1.27 to 3.55), emergency procedure (RR 2.34, 95% CI 1.13 to 4.88), and left ventricular ejection fraction <30% (RR 3.18, 95% CI 1.41 to 7.16) were independent predictors of major adverse cardiac and cerebrovascular events. Patients with left ventricular ejection fraction <30% had a particularly poor survival rate (at 5聽years 67.7% vs 96.1%; adjusted analysis RR 14.01, 95% CI 5.16 to 38.03). Poor left ventricular function, myocardial infarction, diabetes, renal failure, and age <40聽years are major determinants of late outcome after CABG in young patients. In conclusion, data from this real-world registry indicate that multiple arterial grafts and statin treatment are largely underutilized in these patients.