| ObjectiveTo observe the short-mid-and long-term rate of survival, incidence of Major Adverse Cardiac or Cerebrovascular Events (MACCE) and patency rate of graft vessels or stents after coronary artery bypass grafting (CABG) and percutaneous coronary intervention (PCI) in patients aged< 45 years with premature coronary heart disease and compare the clinical and angiographic CT angiographic outcomes between the two revascularization methods in treating young patients with premature coronary heart disease.MethodsA total of 129 patients aged less than 45 years who received CABG between January 2000 and January 2015 in our institution were enrolled to this study and 1362 patients aged less than 45 years who underwent PCI in Department of Cardiology during the same period were selected. The patients were matched at a ratio of 1:1 with 7 major variables (gender, number of diseased vessels, history of myocardial infarction, CCS angina pectoris grade, NYHA classification, LVEF, and comorbidity). Perioperative data of the patients were retrieved from the medical notes. The patients were systematically followed at outpatient clinic and/or through hospitalization, with graft/stent patency assessed with CT angiography. The survival rate, freedom from MACCE, patency rate at 1 year,5 years and 10 years were estimated between two groups.For the patients with single vessel disease of the left anterior descending branch (n=82), the short-, mid-, and long-term clinical outcomes were compared.Results1. The perioperative mortality and incidence of complications were similar (P> 0.05) between two groups.2. The 1 year,5 year and 10 year survival rate of CABG group was 98.3%,98.3%, and 93.7%, and that of PCI group was 98.3%,97.5%,89.2%respectively. There was no significant difference in survival rate between the two groups (P=0.466).3. The rate of freedom from repeat revascularization of CABG group at 1 year,5 years and 10 years was 100%,95.7%, and 90.6%, and that of PCI group was 89.9%,76.0%and 54.6%respectively. CABG group had a higher rate of freedom from repeat revascularization compared with PCI group (P< 0.001).4. The arterial graft patency rate of CABG group at 1 year,5 years and 10 years was 100%,98.8% and 93.5%, whilst the vein graft patency was 100%,89.9% and 72.1%at 1 year,5 years and 10 years. The stents patency rate of PCI group were 92.0%,81.2%and 63.3% at 1 year,5 years and 10 years. CABG group has significant superior patency than PCI group (P<0.05).5. The rate of freedom from MACCE of CABG group at 1 year,5 years and 10 years was 97.4%,90.2%and 75.7%, and that of PCI group was 87.6%,72.2% and 44.1%respectively. The postoperative freedom of MACCE was higher in CABG group than PCI group (P< 0.001).6. For young patients with single vessel disease of the left anterior descending branch, no statistic difference in perioperative mortality and incidence of complications between CABG and PCI groups was found (P>0.05). The survival and the graft/stent patency rate were similar in the mid-and long-term between the two groups (P>0.05). However, CABG group had a significant lower rate of repeat revascularization and MACCE compared with PCI group (P<0.05).ConclusionCABG does not increase operative mortality and incidence of complication compared with PCI, but may have a higher patency rate, lower MACCE rate and lower rate of repeat revascularization after surgery in young patients with premature coronary heart disease.In treating young patients with single vessel disease of the left anterior descending branch, both CABG and PCI are safe and effective, but CABG is superior to PCI with lower rate of MACCE and repeat revascularization in the long-term. |
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