我们评估了接受经皮冠状动脉介入治疗(PCI)的过早和非过早冠状动脉疾病(CAD)患者在风险状况和3年预后方面的差异。
■CAD的患病率随着年龄的增长而增加,然而,有些人在年轻时发展为阻塞性CAD。
■在四项随机全能PCI试验的参与者中,以前没有冠状动脉血运重建或心肌梗死(MI),我们比较了早产儿(男性<50岁,女性<55岁)和非早产儿CAD患者。评估各种临床终点,包括多变量分析。
■在6,171名患者中,887(14.4%)患有早熟CAD。这些患者的危险因素少于非早产儿CAD患者,但更经常吸烟者(60.7%vs.26.4%)和超重(76.2%与69.8%)。此外,早产儿CAD患者更常出现ST段抬高MI,并且接受多血管治疗的频率较低。钙化或分叉病变。此外,早产儿CAD患者的全因死亡风险较低(调整.HR:0.23,95%-CI:0.10-0.52;p<0.001),但目标血管血运重建(调整。HR:1.63,95%-CI:1.18-2.26;p=0.003)和明确的支架血栓形成风险(调整。HR:2.24,95%-CI:1.06-4.72;p=0.034)更高。MACE率无统计学差异(6.6%与9.4%;调整。HR:0.86,95%-CI:0.65-1.16;p=0.33)。
■大约七分之一的PCI患者接受了过早的CAD治疗。这些患者的风险特征低于非早产儿CAD患者;然而,他们反复血运重建和支架内血栓形成的风险较高.由于已知早发CAD患者的终生事件风险特别高,应进一步努力改善可改变的危险因素,如吸烟和超重。
■(TWENTEI,clinicaltrials.gov:NCT01066650),荷兰人民(二,NCT01331707),生物度假村(TWENTEIII,NCT01674803),和BIONYX(TWENTEIV,NCT02508714)。
UNASSIGNED: 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).
UNASSIGNED: The prevalence of CAD increases with age, yet some individuals develop obstructive CAD at younger age.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: 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.
UNASSIGNED: (TWENTE I, clinicaltrials.gov: NCT01066650), DUTCH PEERS (TWENTE II, NCT01331707), BIO-RESORT (TWENTE III, NCT01674803), and BIONYX (TWENTE IV, NCT02508714).