Thirty-Day Mortality After Coronary Artery Bypass Surgery in Patients Aged <50 Years: Results of a Multicenter Study and Meta-Analysis of the Literature

Authors

  • Paola D'Errigo M.Sc.,

    1. National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
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  • Fausto Biancari M.D., Ph.D.,

    Corresponding author
    1. Department of Surgery, Oulu University Hospital, Oulu, Finland
    • National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
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  • Alice Maraschini M.Sc., Ph.D.,

    1. National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
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  • Stefano Rosato M.Sc.,

    1. National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
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  • Gabriella Badoni M.Sc.,

    1. National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
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  • Fulvia Seccareccia M.Sc.

    1. National Centre for Epidemiology, Surveillance and Health Promotion, Istituto Superiore di Sanità, Rome, Italy
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  • Conflict of interest: The authors acknowledge no conflict of interest in the submission.

Address for correspondence: Fausto Biancari, M.D., Ph.D., Department of Surgery, Oulu University Hospital, P.O. Box 21, Oulu 90029, Finland. Fax: +358 8 315 2486; e-mail: faustobiancari@yahoo.it

Abstract

Background

Young patients requiring myocardial revascularization are considered at low operative risk, but data on their outcome are scarce. This study was undertaken to evaluate the prevalence and 30-day mortality of patients aged <50 years after isolated coronary artery bypass surgery (CABG).

Materials and methods

This is a multicenter study including 2207 patients aged <50 years undergoing isolated CABG at 68 Italian hospitals.

Results

The proportion of patients aged <50 years in this series was 5.3% and varied significantly from 0% to 9.9% in different institutions (p < 0.0001). The 30-day mortality rate was 0.9%. One-to-one propensity score matching of patients aged <50 years versus older patients resulted in 2013 pairs whose 30-day mortality was 0.9% and 2.2%, respectively (p = 0.001). Logistic regression showed that left ventricular ejection fraction <30% (OR 5.5, 95% CI 1.6–18.6), peripheral vascular disease (OR 3.6, 95% CI 1.1–12.0), pulmonary hypertension (OR 18.1, 95% CI 1.8–187.0), critical preoperative state (OR 4.7, 95% CI 1.5–14.3), and emergency operation (OR 3.8, 95% CI 1.1–12.9) were independent predictors of 30-day mortality. Meta-analysis of five studies reporting on patients aged <50 years who underwent isolated CABG showed that operative mortality in these patients was 0.9% (95% CI, 0.8–1.1%, I2 0%, 135/14,316 patients).

Conclusions

The proportion of patients aged <50 years undergoing CABG is low and varies significantly among institutions. The results of this study and a meta-analysis of the literature data showed that CABG can be carried out in young patients with an extremely low risk of operative mortality. doi: 10.1111/jocs.12091 (J Card Surg 2013;28:207–211)

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