Long-term Outcomes of Contemporary Coronary Revascularization by Percutaneous Coronary Intervention or Coronary Artery Bypass Grafting in Young Adults

Dror B. Leviner, Guy Witberg, Amir Sharon, Yosif Boulos, Alon Barsheshet, Erez Sharoni, Dan Spiegelstein, Hana Vaknin-Assa, Dan Aravot, Ran Kornowski, Abid Assali

Research output: Contribution to journalArticlepeer-review

Abstract

Background: Current guidelines for choosing between revascularization modalities may not be appropriate for young patients. Objectives: To compare outcomes and guide treatment options for patients < 40 years of age, who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) between 2008 and 2018. Methods: Outcomes were compared for 183 consecutive patients aged < 40 years who underwent PCI or CABG between 2008 and 2018. Outcomes were compared as time to first event and as cumulative events for non-fatal outcomes. Results: Mean patient age was 36.3 years and 96% were male. Risk factors were similar for both groups. Drug eluting stents were implemented in 71% of PCI patients and total arterial revascularization in 74% of CABG patients. During a median follow-up of 6.5 years, 16 patients (8.6%) died. First cardiovascular events occurred in 35 (38.8%) of the PCI group vs. 29 (31.1%) of the CABG group (log rank P = 0.022), repeat events occurred in 96 vs. 51 (P < 0.01), respectively. After multivariate adjustment, CABG was associated with a significantly reduced risk for first adverse event (hazard ratio [HR] 0.305, P < 0.01) caused by a reduction in repeat revascularization. CABG was also associated with a reduction in overall repeat events (HR 0.293, P < 0.01). There was no difference in overall mortality between CABG and PCI. Conclusions: Young patients with coronary disease treated by CABG showed a reduction in the risk for non-fatal cardiac events. Mortality was similar with CABG and PCI.

Original languageEnglish
Pages (from-to)817-822
Number of pages6
JournalIsrael Medical Association Journal
Volume21
Issue number12
StatePublished - 2019
Externally publishedYes

Keywords

  • Coronary artery bypass grafting (CABG)
  • Coronary artery disease (CAD)
  • Percutaneous coronary intervention (PCI)
  • Young adults

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