Impact of Premature Coronary Artery Disease on Adverse Event Risk Following Percutaneous Coronary Intervention

Overview

Journal Front Cardiovasc Med

Specialty Cardiology & Vascular Diseases

Date 2023 Sep 25

PMID 37745109

Authors

Tineke H Pinxterhuis

Eline H Ploumen

Paolo Zocca

Carine J M Doggen

Carl E Schotborgh

Rutger L Anthonio

Ariel Roguin

Peter W Danse

Edouard Benit

Adel Aminian

Marc Hartmann

Gerard C M Linssen

Clemens von Birgelen

Affiliations

Soon will be listed here.

Abstract

Objectives: We assessed differences in risk profile and 3-year outcome between patients undergoing percutaneous coronary intervention (PCI) for and coronary artery disease (CAD).

Background: The prevalence of CAD increases with age, yet some individuals develop obstructive CAD at younger age.

Methods: Among participants in four randomized all-comers PCI trials, without previous coronary revascularization or myocardial infarction (MI), we compared patients with premature (men <50 years; women <55 years) and non-premature CAD. Various clinical endpoints were assessed, including multivariate analyses.

Results: Of 6,171 patients, 887 (14.4%) suffered from premature CAD. These patients had fewer risk factors than patients with non-premature CAD, but were more often smokers (60.7% vs. 26.4%) and overweight (76.2% vs. 69.8%). In addition, premature CAD patients presented more often with ST-segment elevation MI and underwent less often treatment of multiple vessels, and calcified or bifurcated lesions. Furthermore, premature CAD patients had a lower all-cause mortality risk (adj.HR: 0.23, 95%-CI: 0.10-0.52; < 0.001), but target vessel revascularization (adj.HR: 1.63, 95%-CI: 1.18-2.26; = 0.003) and definite stent thrombosis risks (adj.HR: 2.24, 95%-CI: 1.06-4.72; = 0.034) were higher. MACE rates showed no statistically significant difference (6.6% vs. 9.4%; adj.HR: 0.86, 95%-CI: 0.65-1.16; = 0.33).

Conclusions: About one out of seven PCI patients was treated for premature CAD. These patients had less complex risk profiles than patients with non-premature CAD; yet, their risk of repeated revascularization and stent thrombosis was higher. As lifetime event risk of patients with premature CAD is known to be particularly high, further efforts should be made to improve modifiable risk factors such as smoking and overweight.

Twente Trials: (TWENTE I, clinicaltrials.gov: ), DUTCH PEERS (TWENTE II, ), BIO-RESORT (TWENTE III, ), and BIONYX (TWENTE IV, ).

Citing Articles

Long-Term Prognosis after ST-Elevation Myocardial Infarction in Patients with Premature Coronary Artery Disease.

Savic L, Mrdovic I, Asanin M, Stankovic S, Lasica R, Krljanac G J Pers Med. 2024; 14(3).

PMID: 38540974 PMC: 10971173. DOI: 10.3390/jpm14030231.

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