Impact of premature coronary artery disease on adverse event risk following

Objectives

We assessed differences in risk profile and 3-year outcome between patients undergoing percutaneous coronary intervention (PCI) for

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;

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:

Informations de copyright

© 2023 Pinxterhuis, Ploumen, Zocca, Doggen, Schotborgh, Anthonio, Roguin, Danse, Benit, Aminian, Hartmann, Linssen and von Birgelen.

Déclaration de conflit d'intérêts

CvB reports that the research department of Thoraxcentrum Twente has received research grants provided by Abbott Vascular, Biotronik, Boston Scientific, and Medtronic. RLA reports a teaching grant from Biotronik, a license from Sanofi, a speaking fee from Abiomed and support from Amgen for attending a meeting, all outside the submitted work. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.