Acute coronary syndromes in young patients: Phenotypes, causes and clinical outcomes following percutaneous coronary interventions.

Acute Coronary Syndrome / diagnosis Female Humans Male Myocardial Infarction Percutaneous Coronary Intervention / adverse effects Phenotype Risk Factors Treatment Outcome
Acute coronary syndromes Coronary artery disease Coronary artery embolism Spontaneous coronary artery dissection Young

Journal

International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291

Informations de publication

Date de publication:
01 03 2022
Historique:
received: 15 09 2021
revised: 29 12 2021
accepted: 07 01 2022
pubmed: 17 1 2022
medline: 15 3 2022
entrez: 16 1 2022
Statut: ppublish

Résumé

The prevalence of acute coronary syndromes (ACS) among young individuals is increasing, but the phenotypic characteristics, causes and clinical outcomes in this group have not been well described. Between 2009 and 2017, 8712 ACS patients underwent percutaneous coronary intervention (PCI) and were prospectively enrolled. We defined a young patient as female <50 years and male <45 years. The causes of ACS were defined by an adjudication committee. The primary endpoint was the patient-oriented composite endpoint (POCE) of all-cause mortality, myocardial infarction or any revascularization at 12 months. Among 8712 ACS patients, 472 (5.4%) patients were young (26% female). The main cause of ACS in young patients was atherosclerosis (86.5%), followed by coronary artery embolism (9%), and spontaneous coronary artery dissection (SCAD) (4.5%). POCE occurred less frequently in young compared to old patients (8.5% vs. 16.7%, hazard ratio 0.48 (95% confidence interval 0.35-0.66), p < 0.001). The rates of the individual components of the POCE were lower in young including all-cause mortality (3.2% versus 9.5%, 0.32 (0.19-0.54), p < 0.001), myocardial infarction (1.9% versus 3.7%, 0.49 (0.25-0.95), p = 0.035) and any revascularization (5.1% versus 7.4%, 0.65 (0.43-0.97), p = 0.037). Young patients with SCAD had a higher rate of death as compared to those with atherosclerosis, mainly attributed to cardiac deaths. One out of 20 ACS patients undergoing PCI was young and the principal cause was atherosclerosis. Young carry a lower risk for future events compared to older ACS patients. The underlying cause leading to ACS should be considered in appropriate risk stratification of young patients. Clinicaltrials.gov. NCT02241291.

Sections du résumé

BACKGROUND
The prevalence of acute coronary syndromes (ACS) among young individuals is increasing, but the phenotypic characteristics, causes and clinical outcomes in this group have not been well described.
METHODS
Between 2009 and 2017, 8712 ACS patients underwent percutaneous coronary intervention (PCI) and were prospectively enrolled. We defined a young patient as female <50 years and male <45 years. The causes of ACS were defined by an adjudication committee. The primary endpoint was the patient-oriented composite endpoint (POCE) of all-cause mortality, myocardial infarction or any revascularization at 12 months.
RESULTS
Among 8712 ACS patients, 472 (5.4%) patients were young (26% female). The main cause of ACS in young patients was atherosclerosis (86.5%), followed by coronary artery embolism (9%), and spontaneous coronary artery dissection (SCAD) (4.5%). POCE occurred less frequently in young compared to old patients (8.5% vs. 16.7%, hazard ratio 0.48 (95% confidence interval 0.35-0.66), p < 0.001). The rates of the individual components of the POCE were lower in young including all-cause mortality (3.2% versus 9.5%, 0.32 (0.19-0.54), p < 0.001), myocardial infarction (1.9% versus 3.7%, 0.49 (0.25-0.95), p = 0.035) and any revascularization (5.1% versus 7.4%, 0.65 (0.43-0.97), p = 0.037). Young patients with SCAD had a higher rate of death as compared to those with atherosclerosis, mainly attributed to cardiac deaths.
CONCLUSIONS
One out of 20 ACS patients undergoing PCI was young and the principal cause was atherosclerosis. Young carry a lower risk for future events compared to older ACS patients. The underlying cause leading to ACS should be considered in appropriate risk stratification of young patients.
CLINICAL TRIAL REGISTRATION
Clinicaltrials.gov. NCT02241291.

Identifiants

DOI: 10.1016/j.ijcard.2022.01.018 PMID: 35033577
pubmed: 35033577
pii: S0167-5273(22)00065-1
doi: 10.1016/j.ijcard.2022.01.018
pii:
doi:

Banques de données

ClinicalTrials.gov
['NCT02241291']

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

1-8

Informations de copyright

Copyright © 2022. Published by Elsevier B.V.

Auteurs

Christian Zanchin (C)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Stefan Ledwoch (S)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Sarah Bär (S)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Yasushi Ueki (Y)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Tatsuhiko Otsuka (T)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Jonas D Häner (JD)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Thomas Zanchin (T)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Fabien Praz (F)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Lukas Hunziker (L)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Stefan Stortecky (S)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Thomas Pilgrim (T)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Sylvain Losdat (S)

Clinical Trials Unit, University of Bern, Bern, Switzerland.

Stephan Windecker (S)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

Lorenz Räber (L)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: lorenz.raeber@insel.ch.

George C M Siontis (GCM)

Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.

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Classifications MeSH

questionsmedicales.fr › Maladies cardiovasculaires › Maladies vasculaires › Ischémie myocardique › Syndrome coronarien aigu › Acute coronary syndromes in young patients:...
questionsmedicales.fr › Eucaryotes › Animaux › Chordés › Vertébrés › Mammifères › Eutheria › Primates › Haplorhini › Catarrhini › Hominidae › Humains › Acute coronary syndromes in young patients:...
questionsmedicales.fr › États, signes et symptômes pathologiques › Processus pathologiques › Nécrose › Infarctus › Infarctus du myocarde › Acute coronary syndromes in young patients:...
questionsmedicales.fr › Procédures de chirurgie opératoire › Interventions chirurgicales mini-invasives › Procédures endovasculaires › Intervention coronarienne percutanée › Acute coronary syndromes in young patients:...
questionsmedicales.fr › Phénomènes génétiques › Phénotype › Acute coronary syndromes in young patients:...
questionsmedicales.fr › Environnement et santé publique › Santé publique › Méthodes épidémiologiques › Statistiques comme sujet › Probabilité › Risque › Facteurs de risque › Acute coronary syndromes in young patients:...
questionsmedicales.fr › Qualité, accès, évaluation des soins de santé › Qualité des soins de santé › Mécanismes d'évaluation des soins de santé › Évaluation des résultats et des processus en soins de santé › Évaluation de résultat (soins) › Résultat thérapeutique › Acute coronary syndromes in young patients:...