Background Coronary artery disease (CAD) in the young adult is relatively uncommon. It means that these patients are atypical of the general population. The importance of traditional risk factors in this population is not characterized in detail. This study evaluated long-term survival and predictors of elevated risk for young patient diagnosed with CAD.

Methods We identified 287 patients under age 50 (for women) or 45 (for men) with CAD diagnosed by coronary angiography (CAG) in SNUH cardiac database. The initial CAG was done from 1991 to 2007. Mean follow-up duration was 10.2 years. Death, sex, number of diseased vessels, body mass index, prior myocardial infarction (MI), diabetes, hypertension, prior chronic renal failure (CRF), initial lipid profile, ejection fraction (EF), and therapy were studied.

Results The mean age was for women (n=92) and for men (n=195). The average EF was 55 %. 55 % of the subjects had one-vessel disease, and 22 % was diabetic. The strongest predictors of long-term mortality were decreased EF (EF < 50 %) (Hazard ratio [HR] 2.88, 95 % confidence interval [CI] 1.34 to 6.19), prior MI (HR 2.60, 95 % CI 1.34 to 5.02), and prior CRF (HR 2.49, 95 % CI 1.03 to 6.00). Revascularization decreased mortality rather than medical therapy (coronary intervention: HR 0.17, 95 % CI 0.08 to 0.33; coronary artery bypass graft: HR 0.48, 95 % CI 0.14-1.58). Overall cumulative survival rate was 70 % at 10 years. Patient with decreased EF had 10-year survival rate was 30 %, those with prior MI had 10-year survival rate was 36 %.

Conclusion Decreased EF, a prior MI, and prior CRF predict a significantly higher mortality. Traditional cardiac risk factors such as hypertension, diabetes and hypercholesterolemia are not important prognostic factors in young patients with CAD.