Thirty-day mortality after coronary artery bypass surgery in patients aged50 years: results of a multicenter study and meta-analysis of the literature

Young patients requiring myocardial revascularization are considered at low operative risk, but data on their outcome are scarce. This study was undertaken to evaluate the prevalence and 30-day mortality of patients aged50 years after isolated coronary artery bypass surgery (CABG).This is a multicenter study including 2207 patients aged50 years undergoing isolated CABG at 68 Italian hospitals.The proportion of patients aged50 years in this series was 5.3% and varied significantly from 0% to 9.9% in different institutions (p0.0001). The 30-day mortality rate was 0.9%. One-to-one propensity score matching of patients aged50 years versus older patients resulted in 2013 pairs whose 30-day mortality was 0.9% and 2.2%, respectively (p = 0.001). Logistic regression showed that left ventricular ejection fraction30% (OR 5.5, 95% CI 1.6-18.6), peripheral vascular disease (OR 3.6, 95% CI 1.1-12.0), pulmonary hypertension (OR 18.1, 95% CI 1.8-187.0), critical preoperative state (OR 4.7, 95% CI 1.5-14.3), and emergency operation (OR 3.8, 95% CI 1.1-12.9) were independent predictors of 30-day mortality. Meta-analysis of five studies reporting on patients aged50 years who underwent isolated CABG showed that operative mortality in these patients was 0.9% (95% CI, 0.8-1.1%, I(2) 0%, 135/14,316 patients).The proportion of patients aged50 years undergoing CABG is low and varies significantly among institutions. The results of this study and a meta-analysis of the literature data showed that CABG can be carried out in young patients with an extremely low risk of operative mortality.