Coronary artery bypass grafting as a therapy in coronary artery disease in young patients

As doenças cardiovasculares estão entre as principais causas de mortalidade no Brasil e no mundo. Segundo dados da Organização Mundial da Saúde (OMS), das 50 milhões de mortes registradas nas últimas décadas, as doenças cardiovasculares foram responsáveis por 30% dessa mortalidade, ou seja, 17 milhões. Estima-se, para 2020, que esse número se eleve para 35 a 40 milhões. Há algum tempo, a doença arterial coronariana (DAC) predominava em pacientes idosos, porém sabe-se hoje que o processo de doença aterosclerótica tem início cada vez mais precoce. Apesar da prevalência de DAC em adultos jovens ter uma estimativa difícil por ser uma doença silenciosa, dados confirmam que o risco de desenvolvimento com o passar dos anos baseia-se nos fatores de risco presentes quando mais jovens. O objetivo desse estudo é avaliar, no material de nossa instituição, as características clínicas, principais fatores de risco para doença arterial coronária, morbidade e mortalidade hospitalar em pacientes jovens ( 45 anos); avaliar a evolução tardia destes pacientes jovens ( 45 mostraram-se mais sintomáticos no momento da cirurgia. Enxertos com artéria torácica interna foram mais usados nos 45 e 45 anos, foram identificados como fatores prognósticos independentes para óbito: idade (OR 1,061; [IC] 95% 1,047 a 1,075; p=0,0001), lesão de tronco (OR 1,406; [IC] 95% 1,201 a 1,764; p=0,003) e disfunção ventricular grave (OR 1,922; [IC] 95% 1,392 a 2,654; p=0,0001). Os fatores protetores foram: sexo masculino (OR 0,543; [IC] 95% 0,435 a 0,679; p=0,0001) e enxerto com artéria torácica interna (OR 0,516; [IC] 95% 0,395 a 0,675; p=0,0001). Nos pacientes com idade 45 years group, evaluate late evolution of these young patients undergoing coronary artery bypass grafting, with outcomes such as death from any cause. The study analyzed all patients undergoing coronary artery bypass grafting at the Dante Pazzanese Institute of Cardiology from 01/01/1999 to 12/31/2015. Exclusion study criteria were procedures associated with revascularization surgery, such as valve approach or aortic surgery. Analyzed variables were collected in an electronic hospital database (coronary sector of Dante Pazzanese Institute of Cardiology). Associations between qualitative variables were assessed by Pearson\'s Chi-square test or Fisher\'s Exact test, when appropriate. For comparisons with quantitative variables, Student\'s t-test or non-parametric Mann-Whitney test were used if normality assumption has been rejected. Risk factors influence were analyzed throughout multivariable test by Logistic Regression. Event-free survival curves were performed by Kaplan-Meier estimator. Curves were compared using Log-rank test. We considered level of significance as less than or equal to 0.05. Tabulation and statistical analysis of data were performed with SPSS software (Statistical Package for Social Science), version 19.0 (Armonk, NY: IBM Corp.). During this period 8.889 patients underwent surgery, and 408 of them were under 45 years of age. Patients aged 45 years were more symptomatic at the time of surgery. Grafts with internal thoracic arteries were more frequently used in 45 and 45 years, independent prognostic factors for death were age (OR 1,061, 95% 1,047 to 1,075, p = 0,0001), left main coronary lesion (OR 1.406, 95% CI 1.201 to 1.764, p = 0.003) and severe ventriculography (OR 1.922; 95% CI 1.392 to 2.654; p = 0.0001). Protective factors were use of internal thoracic artery grafts (OR 0.516; [CI] 95% 0.395 to 0.675; p = 0.0001) and male gender (OR 0.543; [CI] 95% 0.435 to 0.679; p = 0.0001). In the patient aged