Coronary Artery Disease and Coronary Artery Bypass Surgery in Patients of Middle Age

Abstract

Coronary artery disease in young patients (< 40 years) is not common. However, when it occurs it has symptoms that are more frequent and a more rapid progression when compared to older affected patients. Younger patients are more likely to have normal coronary arteries and have nonobstructive disease < 70%, single-vessel disease and less extensive coronary artery atherosclerosis. Therefore, it is likely that there are differences in the cardiac risk factors in young patients undergoing coronary artery bypass surgery. Smoking, hypercholesterolemia, unstable angina, and myocardial infarction were more frequent in the young age group, and diabetes and hypertension were more common in older patients. The need for repeated interventions, additional surgery andlate myocardial infarction were more common in younger patients. Favorable factors associated with increased survival included the absence of unstable angina, a left ventricle ejection fraction of =45% and the use of the internal thoracic artery for procedures. The patency of saphenous vein grafts in younger patients was inferior to vein graft patency in the older patients. Risk factors such as hyperlipidemia, smoking and a family history of coronary artery disease may be related to the early graft failure in young patients. The patency of the internal thoracic artery to the left anterior descending artery was above 90% over 10 years; however, it was around 50% for the saphenous vein. Therefore, the aggressive use of internal thoracic arteries, for coronary artery bypass surgery in young patients, was essential for improved late survival and the event free survival (reduced additional interventions, surgeries and hospital admissions). The Ycomposite graft technique or sequential anastomosis, improves the coronary artery anastomosis with fewer arterial grafts. Other arterial grafts such as the gastroepiploic artery, radial artery and inferior epigastric artery could be used for coronary artery bypass surgery in young patients for free grafts, in situ grafts or Y-composite grafts. Young patients that have coronary artery bypass surgery have a favorable prognosis when the internal thoracic arteries or other arterial grafts are used. In addition, such as the Y-composite graft technique and sequential anastomosis can also be used with a high success rate.