Abstract
Since the advent of coronary angioplasty, nonoperative techniques to manage coronary artery disease have become attractive alternatives to coronary artery bypass grafting (CABG). To provide a standard against which new procedures could be judged, 123 consecutive patients less than 45 years of age who have had CABG since 1978 were systematically followed. The indications for operation were unstable angina or postinfarction angina (60%), life-threatening coronary anatomy with stable angine (36%), and sudden death or uncontrolled ventricular tachycardia (4%). Seventy-five patients had documented preoperative myocardial infarction, 55% within 30 days of CABG. An average of 3.2 vessels were grafted per patient; only 10 had single CABG. Complete revascularization was accomplished in 91% of patients. Five patients (4%) had myocardial infarction within 30 days of operation. No operative deaths or strokes occurred. The 6-year follow-up was 94.4% (the 5-year actuarial survival rate, 87.4%). There were four late deaths; two were due to myocardial infarction, one to prosthetic valve failure, and one to sudden death. At 2.7 years, 88.1% of the patients were NYHA Functional Class I; 85.4% continued full-time employment, and 98% considered their quality of life the same or better than before CABG. Five patients suffered myocardial infarctions during the follow-up period. Nine patients required reoperation: eight for graft occlusion (three less than 1 year, five greater than 3 years), and one for disease progression. These data confirm that complete operative revascularization remains the standard of therapy for young patients with multivessel coronary artery disease as evidenced by the absence of early mortality, the low incidence of morbidity, the excellent functional recovery, and the high return to gainful employment.
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- Anderson R. P., Rahimtoola S. H., Bonchek L. I., Starr A. The prognosis of patients with coronary artery disease after coronary bypass operations. Time-related progress of 532 patients with disabling angina pectoris. Circulation. 1974 Aug;50(2):274–282. doi: 10.1161/01.cir.50.2.274. [DOI] [PubMed] [Google Scholar]
- Braunwald E. Effects of coronary-artery bypass grafting on survival. Implications of the randomized coronary-artery surgery study. N Engl J Med. 1983 Nov 10;309(19):1181–1184. doi: 10.1056/NEJM198311103091911. [DOI] [PubMed] [Google Scholar]
- Bruschke A. V., Proudfit W. L., Sones F. M., Jr Progress study of 590 consecutive nonsurgical cases of coronary disease followed 5-9 years. I. Arterographic correlations. Circulation. 1973 Jun;47(6):1147–1153. doi: 10.1161/01.cir.47.6.1147. [DOI] [PubMed] [Google Scholar]
- Burggraf G. W., Parker J. O. Prognosis in coronary artery disease. Angiographic, hemodynamic, and clinical factors. Circulation. 1975 Jan;51(1):146–156. doi: 10.1161/01.cir.51.1.146. [DOI] [PubMed] [Google Scholar]
- CUTLER S. J., EDERER F. Maximum utilization of the life table method in analyzing survival. J Chronic Dis. 1958 Dec;8(6):699–712. doi: 10.1016/0021-9681(58)90126-7. [DOI] [PubMed] [Google Scholar]
- Gruentzig A. Results from coronary angioplasty and implications for the future. Am Heart J. 1982 Apr;103(4 Pt 2):779–783. doi: 10.1016/0002-8703(82)90486-0. [DOI] [PubMed] [Google Scholar]
- Kelly T. F., Craver J. M., Jones E. L., Hatcher C. R., Jr Coronary revascularization in patients 40 years and younger: surgical experience and long-term follow-up. Am Surg. 1978 Oct;44(10):675–678. [PubMed] [Google Scholar]
- Lim J. S., Proudfit W. L., Sones F. M., Jr Selective coronary arteriography in young men. A follow-up of 449 patients. Circulation. 1974 Jun;49(6):1122–1126. doi: 10.1161/01.cir.49.6.1122. [DOI] [PubMed] [Google Scholar]
- MAY A. G., DE WEESE J. A., ROB C. G. Hemodynamic effects of arterial stenosis. Surgery. 1963 Apr;53:513–524. [PubMed] [Google Scholar]
- Murphy M. L., Hultgren H. N., Detre K., Thomsen J., Takaro T. Treatment of chronic stable angina. A preliminary report of survival data of the randomized Veterans Administration cooperative study. N Engl J Med. 1977 Sep 22;297(12):621–627. doi: 10.1056/NEJM197709222971201. [DOI] [PubMed] [Google Scholar]
- Pelletier L. C., Pardini A., Renkin J., David P. R., Hébert Y., Bourassa M. G. Myocardial revascularization after failure of percutaneous transluminal coronary angioplasty. J Thorac Cardiovasc Surg. 1985 Aug;90(2):265–271. [PubMed] [Google Scholar]