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. 2023 Sep 7:10:1160201.
doi: 10.3389/fcvm.2023.1160201. eCollection 2023.

Impact of premature coronary artery disease on adverse event risk following first percutaneous coronary intervention

Tineke H Pinxterhuis  1   2 , Eline H Ploumen  1   2 , Paolo Zocca  1 , Carine J M Doggen  2 , Carl E Schotborgh  3 , Rutger L Anthonio  4 , Ariel Roguin  5 , Peter W Danse  6 , Edouard Benit  7 , Adel Aminian  8 , Marc Hartmann  1 , Gerard C M Linssen  9 , Clemens von Birgelen  1   2
Affiliations

Impact of premature coronary artery disease on adverse event risk following first percutaneous coronary intervention

Tineke H Pinxterhuis et al. Front Cardiovasc Med. .

Abstract

Objectives: We assessed differences in risk profile and 3-year outcome between patients undergoing percutaneous coronary intervention (PCI) for premature and non-premature 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; p < 0.001), but target vessel revascularization (adj.HR: 1.63, 95%-CI: 1.18-2.26; p = 0.003) and definite stent thrombosis risks (adj.HR: 2.24, 95%-CI: 1.06-4.72; p = 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; p = 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: NCT01066650), DUTCH PEERS (TWENTE II, NCT01331707), BIO-RESORT (TWENTE III, NCT01674803), and BIONYX (TWENTE IV, NCT02508714).

Keywords: coronary artery disease; drug-eluting stent (DES); obstructive coronary artery disease; percutaneous coronary intervention (or PCI); premature coronary artery disease.

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Conflict of interest statement

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.

Figures

Figure 1
Figure 1
Flowchart. The number of patients with premature coronary artery disease. CABG, coronary artery bypass surgery; MI, myocardial infarction; PCI, percutaneous coronary intervention.
Figure 2
Figure 2
Kaplan–Meier cumulative event curves for the endpoint major adverse cardiac events and its individual components at 3-year follow-up. Kaplan–Meier cumulative incidence curves for: (A) the primary endpoint major adverse cardiac events, a composite of all-cause mortality (B), any myocardial infarction (C), emergent coronary bypass surgery, or clinically indicated target lesion revascularization (D) Patients with premature (orange) and non-premature (purple) coronary artery disease. HR, hazard ratio; MI, myocardial infarction.
See this image and copyright information in PMC

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