Autor:

Wagner, J.; Ennker, J.; Hetzer, R.

Erscheinungsort:

Herz 1996;21:183-91

Inhalt:

This study reviews data on 126 patients (107 men, 19 women) younger than 40 years of age who underwent coronary artery bypass grafting during an 8-year period. They were matched to a control group which also consisted of 126 operated patients but exceeding the age of 39. The majority of the patients in the study group presented with angina; 85.9% were CCS III or IV compared to 61.9% in the control group. More than 3 fourths of the patients (80.5%) had experienced at least 1 myocardial infarction. There was a high incidence of coronary risk factors, especially hyperlipoproteinemia (88.5%), smoking (85.1%), and hypertension (83.1%), whereas in the control group these risk factors occurred in only 49.2%, 21.4%, and 53.2% of the patients, respectively. Other risk factors like diabetes mellitus or family history of coronary artery disease were found in 10.3% and 48.6% of the young patients. While 23.0% of the patients had varying degrees of left main stenosis, 9.5%, 18.3%, and 72.2% had single, double, and triple vessel disease, respectively. Left ventriculograms showed serious functional impairment (ejection fraction less than 40%) in 22.2% of the patients. A total of 286 saphenous vein grafts (2.3 grafts per patient) and 126 internal mammarian grafts were implanted, whereby an internal mammarian graft was always used. In 6 patients we used an intermittent mechanical support system (intraaortic balloon pump in 5 patients and an assist device in 1). In-hospital mortality rate was 1.6% (2 patients); long-term mortality rate 5.2% (mean follow-up interval 54 +/- 20 months). Actuarial survival was 93.0%, 89.8%, and 89.8% at 3,5, and 7 years, respectively. Survival in patients with normal and impaired ejection fraction was significantly different (p < 0.035) for 5-year and 7-year survival (100% vs. 81.8%). We observed encouraging intermediate term results in young adult patients after coronary revascularization. This may have been due to the consistent use of internal mammary artery grafts.