Author + information
- Lakshmana K. Pendyala,
- Joshua P. Loh,
- Hironori Kitabata,
- Minha Sa'ar,
- Rebecca Torguson,
- Israel Barbash,
- Salem Badr,
- Danny Dvir,
- Satler Lowell,
- Augusto Pichard and
- Waksman Ron
There is paucity of data on the risk variables, clinical presentation and long term outcomes in patients presenting with symptomatic premature coronary artery disease (CAD). This study is done to understand the gender differences in risk factors for premature atherosclerosis and also evaluate the determinants of adverse outcomes after contemporary PCI in young patients.
Study included 167 consecutive patients aged ≤ 40 years treated with PCI with stent in our institution from January 2004 to May 2011.Baseline characteristics, clinical presentation, in-hospital and long-term outcomes were analyzed. We report the rates of major adverse cardiovascular events (MACE), defined as all-cause mortality, myocardial infarction (MI), and target lesion revascularization at 1-year follow-up. Independent correlates of adverse outcomes were identified using multivariable proportional hazard regression analysis.
In this young group of patients (age 37±3 yr), females have higher prevalence of diabetes mellitus (p =0.002), insulin dependent diabetes mellitus (p<0.001), chronic renal insufficiency (p=0.02), congestive heart failure (p =0.006) and lower hematocrit (p <0.001) compared to males. African Americans constitute 52% of the females compared to 25% seen in males (p=0.001). The in-hospital mortality is 2.4%, similar between the groups except higher rate of blood transfusions in women. At 1 year, the MACE rates (22% vs. 10%, p=0.04) were higher in women. Baseline hematocrit and number of lesions treated were independent correlates of MACE events at one year.
Special care should be directed to female patients presenting to catheterization lab with symptomatic premature CAD, as theses young females have high rate of co-morbidities and their longterm procedural outcomes are poor compared to younger males.
|Variable [n (%)]||Whole group (n=167)||Female (n=46)||Male (n=121)||P value|
|Mean age (years±SD)||37±3||36±4||37±3||0.19|
|Diabetes mellitus||50 (30%)||22 (48%)||28 (23%)||0.002|
|Insulin-dependent diabetes||22 (13%)||14 (30%)||8 (7%)||<0.001|
|Congestive heart failure||8 (5%)||6 (14%)||2 (2%)||0.006|
|Chronic renal insufficiency||13 (8%)||7 (15%)||5 (4%)||0.02|
|TLR MACE (1 year)||22 (13%)||10 (22%)||12 (10%)||0.04|
|TVR MACE (1 year)||29 (17%)||13 (28%)||16 (13%)||0.02|
|Death (1 year)||8 (4.8%)||4 (9%)||4 (3.4%)||0.22|
- 2013 American College of Cardiology Foundation