Premature coronary artery disease and 1-year outcomes after PCI
S Janssen, D A M Peeters, E C I Woelders, P J C Winkler, J J P Luijkx, W S Remkes, P Damman, S Rasoul, R J M van Geuns, A W J van 't HofAbstract
Background
Premature coronary artery disease (CAD) affects patients at a young age and places a significant burden on patients’ quality of life and societal productivity. Contemporary real-world data on PCI outcomes in this population are scarce.
Purpose
This study sought to evaluate the prevalence, clinical profile, and 1-year outcomes of patients with premature CAD undergoing percutaneous coronary intervention (PCI).
Methods
We analysed data from the Southeast Netherlands Heart Registry (ZON-HR), an ongoing, multicentre PCI registry. Premature CAD was defined as PCI at age <50 years in men and <55 years in women. Baseline characteristics were compared between premature CAD and older patients. The primary endpoint was 1-year major adverse cardiac and cerebrovascular events (MACCE), defined as a composite of myocardial infarction, unplanned revascularisation, ischemic stroke, stent thrombosis, or cardiovascular mortality. Cox proportional hazards modelling was performed to assess the independent association between premature CAD and 1-year MACCE.
Results
Among 8,767 patients undergoing PCI, 584 (6.7%) met criteria for premature CAD (mean age of 46 years). Compared with older patients, those with premature CAD more frequently presented with acute coronary syndrome or out-of-hospital cardiac arrest and had lower baseline socioeconomic status. They had higher body mass index (28.8 vs 27.6 kg/m2) and LDL-cholesterol (3.3 vs 2.7 mmol/L), and were more often active smokers (56% vs 22%). In contrast, hypertension, diabetes, peripheral artery disease, or multivessel disease were less prevalent. Unadjusted 1-year MACCE rates were similar between groups. However, after multivariable adjustment, premature CAD was independently associated with a higher risk of MACCE (HR 1.95, 95% CI 1.17-3.25, p=0.011).
Conclusion
In this registry, premature CAD accounted for almost 7% of patients undergoing PCI. Despite a lower burden of traditional comorbidities, these patients had an increased adjusted risk of 1-year MACCE. These findings underscore the need for intensified secondary prevention and attention to both clinical and socioeconomic risk factors in this high-risk subgroup.Risk of 1-year MACCE premature CADFor image description, please refer to the figure legend and surrounding text.