Outcomes of coronary artery bypass grafting inpatients under 45 years with acute myocardial infarction_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

LI Yang ,  DONG Ran , LIU Taoshuai , ZHENG Jubing , ZHOU Ning , ZHOU Shaoyou , HUANG Zhuhui , ZHAO Yang , ZHANG Kui

The 11th Ward, Department of Cardiac Surgery, Bejing Anzhen Hospital, Capital Medical University, Beijing, 100029, P.R.China;

Corresponding author：

DONG Ran, Email: dongran6618@hotmail.com

Keywords：

Coronary artery bypass grafting; acute myocardial infarction; age under 45 years; major adverse cardiac and cerebrovascular events

DOI：

10.7507/1007-4848.201903015

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Objective To investigate the early and long-outcomes of coronary artery bypass grafting(CABG) in acute myocardial infarction (AMI) patients with coronary artery disease(CAD)(age≤45 years). Methods Data of 596 adult CAD patients (include AMI and Angina) who underwent CABG in our hospital were collected retrospectively from May 2010 to October 2018. In an AMI group, 234 were male patients with an average age of 41.59±3.79 years; 26 were female patients with an average age of 41.64±3.03 years. In an angina group, 280 were male patients with an average age of 42.19±2.90 years; 56 were female patients with an average age of 41.54±3.52 years. Preoperative baseline variables, perioperative mortality, major adverse cardiac and cerebrovascular events (MACCE) were compared between two group. Results There was no significant difference in all preoperative variables. Seven patients were died and the hospital mortality rate was 1.23% (1.54% vs. 0.89%, P=0.477). The complications including reoperation for bleeding, cerebral infarction, renal failure and atrial fibrillation arrhythmia were without significant difference between two group (P>0.05). The intensive care unit stay duration (30.66±27.46 h vs. 23.96±15.11 h), intubation duration (22.54±22.31 h vs. 18.64±11.81 h) and hospitalization costs (97 186±33 741¥ vs. 90 081±24 537¥, P=0.003) were greater in the AMI group. The hospital mortality rate and complications rate were without significant difference between STEMI (ST segment elevated myocardial infarction) and NSTEMI (non-ST-segment elevated myocardial infarction) subgroups (P>0.05). The follow-up rate was 92.6% (546 patients) and the follow-up time was 4 (0.5 to 8.5) years. All cause-mortality rate was 3.85% (21 patients), and freedom MACCE was 72.2%. The freedom from MACCE, recurred angina and cerebral infarction were without significant difference, but AMI was associated with higher rate of PCI procedure. Conclusion CABG procedure in CAD patients under 45 years accompanied AMI is safety and reliable both in early and the long-term outcomes.

Citation： LI Yang, DONG Ran, LIU Taoshuai, ZHENG Jubing, ZHOU Ning, ZHOU Shaoyou, HUANG Zhuhui, ZHAO Yang, ZHANG Kui. Outcomes of coronary artery bypass grafting inpatients under 45 years with acute myocardial infarction. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2019, 26(11): 1107-1112. doi: 10.7507/1007-4848.201903015 Copy

1.	Parikh SV, de Lemos JA, Jessen ME, et al. Timing of in-hospital coronary artery bypass graft surgery for non-ST-segment elevation myocardial infarction patients results from the National Cardiovascular Data Registry ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines). JACC Cardiovasc Interv, 2010, (4): 419-427.
2.	Fleissner F, Warnecke G, Cebotari S, et al. Coronary artery bypass grafting in young patients-insights into a distinct entity. J Cardiothorac Surg, 2015, (10): 65.
3.	Kristian T, Joseph SA, Allan SJ, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J, 2019, 40(3): 237-269.
4.	Deo R, Albert CM. Epidemiology and genetics of sudden cardiac death. Circulation, 2012, 125(4): 620-637.
5.	Rawshani A, Landin-Olsson M, Svensson AM, et al. The incidence of diabetes among 0-34 year olds in Sweden: new data and better methods. Diabetologia, 2014, 57(7): 1375-1381.
6.	陈都, 徐峰, 陆士奇, 等. 急性心肌梗死早期血清超敏C反应蛋白和前白蛋白与并发急性心力衰竭的关系. 中华急诊医学杂志, 2014, (1): 75-78.
7.	Yao HM, Sun TW, Wan YD, et a1. Domestic versus imported drug—eluting stents for the treatment of patients with acute coronary syndrome. World J Emergency Med, 2014, 5(3): 175-181.
8.	项美香, 马宏, 王建安. 提高急性冠脉综合征的认识与诊治. 中华急诊医学杂志, 2012, (7): 677-679.
9.	Fournier JA, Cabezon S, Cayuela A, et al. Long-term prognosis of patients having acute myocardial infarction when ≤40 years of age. Am J Cardiol, 2004, 15(94): 989-992.
10.	Sinha SK, Krishna V, Thakur R, et al. Acute myocardial infarction in very young adults: A clinical presentation, risk factors, hospital outcome index, and their angiographic characteristics in North India-AMIYA Study. ARYA Atheroscler, 2017, 13(2): 79-87.
11.	Ismail J, Jafor TH, Jafaray FH. Risk factors for non-fatal MI in young south Asian adults. Heart, 2004, (90): 259-263.
12.	Nichols EL, McCullough JN, Ross CS, et al. Optimal timing from myocardial infarction to coronary artery bypass grafting on hospital mortality. Ann Thorac Surg, 2017, 103(1): 162-171.
13.	Malik FTN, Kalimuddin M, Ahmed N, et al. AMI in very young (aged ≤35 years) Bangladeshi patients: Risk factors and coronary angiographic profile. Clin Trials Regul Sci Cardiol, 2016, 1-5.
14.	Gotsman I, Lotan C, Mosseri M. Clinical manifestations and outcome of acute myocardial infarction in very young patients. Isr Med Assoc J, 2003, 5(9): 633-636.
15.	SoS Investigators. Coronary artery bypass surgery versus percutaneous coronary intervention with stent implantation in patients with multivessel coronary artery disease (the Stent or Surgery trial): a randomised controlled trial. Lancet, 2002, 360(9338): 965-970.
16.	Miyahara K, Matsuura A, et al. On-pump beating-heart coronary artery bypass grafting after acute myocardial infarction has lower mortality and morbidity. J Thorac Cardiovasc Surg, 2018, 135(3): 521-526.
17.	Zhu MZL, Huq MM, Billah BM, et al. On-pump beating heart versus conventional coronary artery bypass grafting early after myocardial infarction: A propensity-score matched analysis from the ANZSCTS database. Heart Lung Circ, 2018, S1443-9506(18)31802-X.
18.	Deeik RK, Schmitt TM, et al. Appropriate timing of elective coronary artery bypass graft surgery following acute myocardial infarction. Am J Surg, 1998, 176(6): 581-585.
19.	Häkkinen U, Rosenqvist G, Peltola M, et al. Quality, cost, and their trade-off in treating AMI and stroke patients in European hospitals. Health Policy, 2014, 117(1): 15-27.

1. Parikh SV, de Lemos JA, Jessen ME, et al. Timing of in-hospital coronary artery bypass graft surgery for non-ST-segment elevation myocardial infarction patients results from the National Cardiovascular Data Registry ACTION Registry-GWTG (Acute Coronary Treatment and Intervention Outcomes Network Registry-Get With The Guidelines). JACC Cardiovasc Interv, 2010, (4): 419-427.
2. Fleissner F, Warnecke G, Cebotari S, et al. Coronary artery bypass grafting in young patients-insights into a distinct entity. J Cardiothorac Surg, 2015, (10): 65.
3. Kristian T, Joseph SA, Allan SJ, et al. Fourth universal definition of myocardial infarction (2018). Eur Heart J, 2019, 40(3): 237-269.
4. Deo R, Albert CM. Epidemiology and genetics of sudden cardiac death. Circulation, 2012, 125(4): 620-637.
5. Rawshani A, Landin-Olsson M, Svensson AM, et al. The incidence of diabetes among 0-34 year olds in Sweden: new data and better methods. Diabetologia, 2014, 57(7): 1375-1381.
6. 陈都, 徐峰, 陆士奇, 等. 急性心肌梗死早期血清超敏C反应蛋白和前白蛋白与并发急性心力衰竭的关系. 中华急诊医学杂志, 2014, (1): 75-78.
7. Yao HM, Sun TW, Wan YD, et a1. Domestic versus imported drug—eluting stents for the treatment of patients with acute coronary syndrome. World J Emergency Med, 2014, 5(3): 175-181.
8. 项美香, 马宏, 王建安. 提高急性冠脉综合征的认识与诊治. 中华急诊医学杂志, 2012, (7): 677-679.
9. Fournier JA, Cabezon S, Cayuela A, et al. Long-term prognosis of patients having acute myocardial infarction when ≤40 years of age. Am J Cardiol, 2004, 15(94): 989-992.
10. Sinha SK, Krishna V, Thakur R, et al. Acute myocardial infarction in very young adults: A clinical presentation, risk factors, hospital outcome index, and their angiographic characteristics in North India-AMIYA Study. ARYA Atheroscler, 2017, 13(2): 79-87.
11. Ismail J, Jafor TH, Jafaray FH. Risk factors for non-fatal MI in young south Asian adults. Heart, 2004, (90): 259-263.
12. Nichols EL, McCullough JN, Ross CS, et al. Optimal timing from myocardial infarction to coronary artery bypass grafting on hospital mortality. Ann Thorac Surg, 2017, 103(1): 162-171.
13. Malik FTN, Kalimuddin M, Ahmed N, et al. AMI in very young (aged ≤35 years) Bangladeshi patients: Risk factors and coronary angiographic profile. Clin Trials Regul Sci Cardiol, 2016, 1-5.
14. Gotsman I, Lotan C, Mosseri M. Clinical manifestations and outcome of acute myocardial infarction in very young patients. Isr Med Assoc J, 2003, 5(9): 633-636.
15. SoS Investigators. Coronary artery bypass surgery versus percutaneous coronary intervention with stent implantation in patients with multivessel coronary artery disease (the Stent or Surgery trial): a randomised controlled trial. Lancet, 2002, 360(9338): 965-970.
16. Miyahara K, Matsuura A, et al. On-pump beating-heart coronary artery bypass grafting after acute myocardial infarction has lower mortality and morbidity. J Thorac Cardiovasc Surg, 2018, 135(3): 521-526.
17. Zhu MZL, Huq MM, Billah BM, et al. On-pump beating heart versus conventional coronary artery bypass grafting early after myocardial infarction: A propensity-score matched analysis from the ANZSCTS database. Heart Lung Circ, 2018, S1443-9506(18)31802-X.
18. Deeik RK, Schmitt TM, et al. Appropriate timing of elective coronary artery bypass graft surgery following acute myocardial infarction. Am J Surg, 1998, 176(6): 581-585.
19. Häkkinen U, Rosenqvist G, Peltola M, et al. Quality, cost, and their trade-off in treating AMI and stroke patients in European hospitals. Health Policy, 2014, 117(1): 15-27.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Outcomes of coronary artery bypass grafting inpatients under 45 years with acute myocardial infarction

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