• Dror B Leviner, Guy Witberg, Amir Sharon, Yosif Boulos, Alon Barsheshet, Erez Sharoni, Dan Spiegelstein, Hana Vaknin-Assa, Dan Aravot, Ran Kornowski, and Abid Assali.
• Department of Cardiothoracic Surgery, Carmel Medical Center, Haifa, Israel.
• Isr Med Assoc J. 2019 Dec 1; 21 (12): 817-822.

BackgroundCurrent guidelines for choosing between revascularization modalities may not be appropriate for young patients.ObjectivesTo compare outcomes and guide treatment options for patients < 40 years of age, who underwent percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) between 2008 and 2018.MethodsOutcomes were compared for 183 consecutive patients aged < 40 years who underwent PCI or CABG between 2008 and 2018, Outcomes were compared as time to first event and as cumulative events for non-fatal outcomes.ResultsMean patient age was 36.3 years and 96% were male. Risk factors were similar for both groups. Drug eluting stents were implemented in 71% of PCI patients and total arterial revascularization in 74% of CABG patients. During a median follow-up of 6.5 years, 16 patients (8.6%) died. First cardiovascular events occurred in 35 (38.8%) of the PCI group vs. 29 (31.1%) of the CABG group (log rank P = 0.022), repeat events occurred in 96 vs. 51 (P < 0.01), respectively. After multivariate adjustment, CABG was associated with a significantly reduced risk for first adverse event (hazard ratio [HR] 0.305, P < 0.01) caused by a reduction in repeat revascularization. CABG was also associated with a reduction in overall repeat events (HR 0.293, P < 0.01). There was no difference in overall mortality between CABG and PCI.ConclusionsYoung patients with coronary disease treated by CABG showed a reduction in the risk for non-fatal cardiac events. Mortality was similar with CABG and PCI.

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