Coronary Artery Bypass Grafting in Patients 50 Years or Younger: A Swedish Nationwide Cohort Study
Background—There is limited data regarding long-term results after coronary artery bypass grafting (CABG) in young adults. We performed a nationwide population-based cohort study to analyze long-term survival, major adverse cardiovascular events, and factors associated with elevated risk in young adults undergoing CABG.
Methods and Results—We included all adult patients 50 years or younger who underwent primary isolated CABG in Sweden between 1997-2013 from the SWEDEHEART register. Patient data were linked from national Swedish health-data registers to create a study database. We identified 4,086 young adults with a mean age of 46 years and 18% women. During a median follow-up time of 10.9 years (IQR: 6.4-14.1) 490 (12%) patients died. Survival at 5, 10, and 15 years was 96% (95%CI: 95-96), 90% (95%CI: 89-91), and 82% (95%CI: 80-83), respectively, which was significantly better compared with patients aged 51-70 years and >70 years who underwent CABG during the same period. The cumulative incidence of death or a major adverse cardiovascular event during 16 years after CABG was mainly driven by myocardial infarction or need for repeat revascularization. The most important risk factors for all-cause mortality were chronic kidney disease, reduced left ventricular ejection fraction, peripheral vascular disease or chronic obstructive pulmonary disease.
Conclusions—Long-term survival and freedom from major cardiovascular events after CABG was better in young adults compared with older patients. Factors significantly associated with an elevated long-term risk of death or adverse outcome were similar to well-known risk factors for older age groups following CABG.
Clinical Trial Registration Information—http://clinicaltrials.gov. Identifier: NCT02276950.
- Received November 19, 2014.
- Revision received January 23, 2015.
- Accepted February 19, 2015.