Coronary atherosclerosis has been commonly recognized in young patients since pathologic studies were published demonstrating coronary disease in young soldiers killed during the Korean War. Since then, there have been a number of studies of coronary artery disease in young patients. Gertler et al followed patients for 15 years who had their first coronary episode at an age younger than 35 years. They found that the long-term prognosis for these patients was worse with decreasing age of the first coronary episode. Although the early mortality after myocardial infarction in their young patients was approximately equal to that in older patients, a higher number of the young patients (45 percent) succumbed to a subsequent recurrent myocardial infarction. Other authors felt the outcome for young patients after myocardial infarction was better than for older patients; however, many of these patients were over the age of 35 and would have been considered “middle-aged” in our study. An increased long-term mortality after myocardial infarction in young patients is despite the fact that various angiographic series demonstrate a 50 to 60 percent incidence of single-vessel disease in young patients. In our series of young patients, 27.5 percent had single-vessel disease, 25 percent had two-vessel disease, 47.5 percent had three-vessel disease, and 10 percent had left main coronary artery disease.
Overall summary statistics are shown in Tables 1 through 4. As a function of groups, there was no significant difference in any of the variables studied except for the preoperative duration of angina which was shorter in the young and middle-age groups vs the old, and the occurrence of hypertension and of diabetes which were both more common in the old group vs young, and the occurrence of hyperlipidemia which was slightly more prevalent in the young group. Moreover, except for hyperlipidemia, there was no variable where the young were at any disadvantage to the other two groups. Other than the variables already noted, there were no significant differences in the young vs middle-aged and middle-aged vs old comparisons. It should be noted that occurrence of diabetes in a military population would be expected to be low as a result of exclusion of diabetics on military entrance physicals. There was also no difference in distribution of numbers of cardiac risk factors among the three age groups (Table 5).
Coronary artery bypass surgery has become recognized as valuable therapy for angina in patients with fixed coronary artery obstruction. It also appears that patients with left main coronary lesions or with lesions in all three major coronary arteries have increased life expectancy after coronary artery bypass when compared with similar patients treated medically. In our military patient population, we see a significant volume of young patients with atherosclerotic coronary vascular disease who are being treated with coronary artery bypass grafting. Young patients with atherosclerotic coronary vascular disease, at least when manifested by myocardial infarction, have been shown to have a poor prognosis when treated medically. Other investigators have shown that young patients who suffer myocardial infarction fare better than do older patients. It seems important to determine critically whether young patients with coronary artery disease fare well when treated with coronary artery bypass grafting. Consequently, we have conducted a retrospective case-control study in order to investigate whether subsequent morbidity and mortality from coronary artery bypass surgery are the same in young patients as it is in middle-aged or older patients.