Complete surgical revascularization: the treatment of choice in young patients with multivessel coronary disease.

Since the advent of coronary angioplasty, nonoperative techniques to manage coronary artery disease have become attractive alternatives to coronary artery bypass grafting (CABG). To provide a standard against which new procedures could be judged, 123 consecutive patients less than 45 years of age who have had CABG since 1978 were systematically followed. The indications for operation were unstable angina or postinfarction angina (60%), life-threatening coronary anatomy with stable angine (36%), and sudden death or uncontrolled ventricular tachycardia (4%). Seventy-five patients had documented preoperative myocardial infarction, 55% within 30 days of CABG. An average of 3.2 vessels were grafted per patient; only 10 had single CABG. Complete revascularization was accomplished in 91% of patients. Five patients (4%) had myocardial infarction within 30 days of operation. No operative deaths or strokes occurred. The 6-year follow-up was 94.4% (the 5-year actuarial survival rate, 87.4%). There were four late deaths; two were due to myocardial infarction, one to prosthetic valve failure, and one to sudden death. At 2.7 years, 88.1% of the patients were NYHA Functional Class I; 85.4% continued full-time employment, and 98% considered their quality of life the same or better than before CABG. Five patients suffered myocardial infarctions during the follow-up period. Nine patients required reoperation: eight for graft occlusion (three less than 1 year, five greater than 3 years), and one for disease progression. These data confirm that complete operative revascularization remains the standard of therapy for young patients with multivessel coronary artery disease as evidenced by the absence of early mortality, the low incidence of morbidity, the excellent functional recovery, and the high return to gainful employment.