First Myocardial Infarction in Patients with Premature Coronary Artery Disease: Insights into Patient Characteristics and Outcome after Treatment with Contemporary Stents
Tineke H Pinxterhuis, Eline H Ploumen, Carine J M Doggen, Marc Hartmann, Carl E Schotborgh, Rutger L Anthonio, Ariel Roguin, Peter W Danse, Edouard Benit, Adel Aminian, Gerard C M Linssen, Clemens von Birgelen- Cardiology and Cardiovascular Medicine
- Critical Care and Intensive Care Medicine
- General Medicine
Abstract
Background
Patients with premature coronary artery disease (CAD) have a higher incidence of myocardial infarction (MI) than patients with non-premature CAD. Yet, it is unknown whether these patient groups differ in clinical outcome after a first acute MI, percutaneously treated with new-generation drug-eluting stents.
Methods
We pooled and analyzed the characteristics and clinical outcome of all patients with a first MI (and no previous coronary revascularization) at time of enrolment, in four large-scale drug-eluting stent trials. CAD was classified premature in men <50 and women <55 years. MI patients with premature and non-premature CAD were compared. Main endpoint was major adverse cardiac events (MACE): all-cause mortality, any myocardial infarction, emergent coronary artery bypass surgery, or clinically indicated target lesion revascularization.
Results
Of 3,323 patients with a first MI, 582(17.5%) had premature CAD. These patients had lower risk profiles and underwent less complex interventional procedures than patients with non-premature CAD. At 30-days follow-up, the rates of MACE (HR:0.22, 95%-CI:0.07-0.71; p = 0.005), MI (HR:0.22, 95%-CI:0.05-0.89; p = 0.020), and target vessel failure (HR:0.30, 95%-CI:0.11-0.82; p = 0.012) were lower in patients with premature CAD. At 1-year, premature CAD was independently associated with lower rates of MACE (adjHR:0.50, 95%-CI:0.26-0.96; p = 0.037) and all-cause mortality (adjHR:0.24, 95%-CI:0.06-0.98; p = 0.046). At 2-years, premature CAD was independently associated with lower mortality (adjHR:0.16, 95%-CI:0.05-0.50; p = 0.002).
Conclusions
First MI patients with premature CAD, treated with contemporary stents, showed lower rates of MACE and all-cause mortality than patients with non-premature CAD, which is most likely related to differences in cardiovascular risk profile.