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Am J Cardiol. 2014 Jul 15;114(2):198-205. doi: 10.1016/j.amjcard.2014.04.025. Epub 2014 May 2.

Comparison of 30-day and 5-year outcomes of percutaneous coronary intervention versus coronary artery bypass grafting in patients aged≤50 years (the Coronary aRtery diseAse in younG adultS Study).

Author information

1
Department of Surgery, Oulu University Hospital, Oulu, Finland. Electronic address: faustobiancari@yahoo.it.
2
Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavík, Iceland.
3
Department of Surgery, Oulu University Hospital, Oulu, Finland.
4
Department of Internal Medicine, Oulu University Hospital, Oulu, Finland.
5
Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
6
Cardiac Surgery Unit, Azienda Ospedaliero Universitaria (A.O.U.) Policlinico-Vittorio Emanuele, University of Catania, Catania, Italy.
7
Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
8
Department of Anesthesiology, Vaasa Central Hospital, Vaasa, Finland.
9
Department of Surgery, Vaasa Central Hospital, Vaasa, Finland.
10
Department of Internal Medicine, Vaasa Central Hospital, Vaasa, Finland.
11
Division of Cardiac Surgery, University of Verona Medical School, Verona, Italy.
12
Division of Cardiology, Department of Medicine, University of Verona Medical School, Verona, Italy.
13
Department of Cardiology, Faculty of Medicine, University of Iceland, Reykjavík, Iceland.
14
Heart Center, Satakunta Central Hospital, Pori, Finland.
15
Heart Center, Tampere University Hospital, Tampere, Finland.
16
Department of Cardiothoracic and Respiratory Sciences, V. Monaldi Hospital, Naples, Italy.

Abstract

Data on the outcome of young patients after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) are scarce. Data on 2,209 consecutive patients aged≤50 years who underwent CABG or PCI were retrospectively collected from 15 European institutions. PCI and CABG had similar 30-day mortality rates (0.8% vs 1.4%, p=0.27), late survival (at 5 years, 97.8% vs 94.9%, p=0.082), and freedom from stroke (at 5 years, 98.0% and 98.0%, p=0.731). PCI was associated with significantly lower freedom from major adverse cardiac and cerebrovascular events (at 5 years, 73.9% vs 85.0%, p<0.0001), repeat revascularization (at 5 years, 77.6% vs 92.5%, p<0.0001), and myocardial infarction (at 5 years, 89.9% vs 96.6%, p<0.0001) compared with CABG. These findings were confirmed in propensity score-adjusted and matched analyses. Freedom from major adverse cardiac and cerebrovascular events after PCI was particularly low in diabetics (at 5 years, 58.0% vs 75.9%, p<0.0001) and in patients with multivessel disease (at 5 years, 63.6% vs 85.1%, p<0.0001). PCI in patients with ST elevation myocardial infarction was associated with significantly better 5-year survival (97.5% vs 88.8%, p=0.001), which was driven by its lower 30-day mortality rate (1.5% vs 6.0%, p=0.017). In conclusion, patients aged≤50 years have an excellent immediate outcome after either PCI or CABG with similar long-term survival when used according to the current clinical practice. PCI was associated with significantly lower freedom from myocardial infarction and repeat revascularization.

TRIAL REGISTRATION:

ClinicalTrials.gov NCT01838746.

PMID:
24878127
DOI:
10.1016/j.amjcard.2014.04.025
[Indexed for MEDLINE]

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