Outcome Following Coronary Balloon Angioplasty in Young Adults Aged 35 Years or Less

The natural history of symptomatic young patients with coronary artery disease is often far from benign. Follow‐up studies of young patients who have undergone coronary bypass graft surgery show frequent recurrence of symptoms and need for reoperation. Prompted by these considerations, we reviewed the records of 23 consecutive patients aged ≤ 35 years with symptomatic coronary artery disease, who underwent coronary balloon angioplasty at our center between August, 1984 and November, 1989. Mean patient age was 32 (3) (mean [SD]) years. Acute myocardial infarction was the first symptom of coronary artery disease in 7 (30%) of the 23 patients. At the time of angioplasty, 17 (74%) patients, had functional Class 3 or 4 anginal symptoms. Eight (35%) had multivessel coronary artery disease (stenoses ≥ 70% in two or more major coronary arteries). Overall, a total of 36 critical coronary lesions were identified in 32 vessels of the 23 patients (mean of 1.6 lesions and 1.4 diseased vessels per patient). At angioplasty, dilatation of 31 lesions in 27 vessels was attempted. Multilesion angioplasty was attempted in 7 (30%) patients. Successful dilatation was achieved in 29 of the 31 (94%) lesions, and 25 of the 27 (93%) vessels. Primary clinical success (successful dilatation of all attempted lesions without any complications) was achieved in 21 of 23 (91%) patients. Three of the 21 patients with successful initial angioplasty had repeat angioplasty for restenosis. In all three, repeat angioplasty was performed 3 months after initial angioplasty and was successful. At a mean follow‐up of 25 (16) (range 5–71) months, 18 of the 21 patients with successful initial angioplasty have remained asymptomatic following one (15 patients) or two (three patients) angioplasty procedures; one patient underwent elective coronary bypass surgery and one patient had a fatal myocardial infarction. Taking into account the often accelerated atherosclerotic disease process in young adults with clinical coronary artery disease, these data suggest coronary balloon angioplasty should be considered favorably in selected young patients with symptomatic obstructive coronary artery disease.