Coronary artery bypass surgery in young patients

Myocardial infarction in young patients

Myocardial infarction in persons under the age of 45 years accounts for 6% to 10% of all myocardial infarctions in the United States. In this age group, it is predominantly a disease of men. Important risk factors include a family history of myocardial infarction before age 55 years, hyperlipidemia, smoking, and obesity. Unlike older patients, approximately half of young patients have single-vessel coronary disease, and in up to 20%, the cause is not related to atherosclerosis. Coronary angiography may be warranted in young patients with myocardial infarction to define the anatomy of the disease and to permit optimal management.

Coronary Artery Bypass in Asian Patients

Coronary artery disease in Asians deserves far more attention than it has received in the literature to date. Most of the available reports focus on immigrants from the Indian subcontinent. These immigrants have a significantly higher risk of coronary artery disease than either their compatriots who do not emigrate or the indigenous population of their adopted countries. This finding cannot be explained on the basis of standard coronary risk factors. There is a general clinical impression that Asians of all nationalities have smaller coronary arteries and more diffuse coronary disease than other ethnic groups; therefore, they are less suitable candidates for conventional bypass grafting. This impression remains a source of controversy. Our experience at the Texas Heart Institute indicates that, after coronary bypass surgery, early and long-term results in Asians are as satisfactory as in other ethnic groups. However, much more research is needed to explain the many paradoxical aspects of coronary disease in Asian patients.