Related Experiment Videos
Coronary angioplasty in the young: procedural results and late outcome
V K Mehan1, P Urban, P A Dorsaz
1Cardiology Center, University Hospital, Geneva, Switzerland.
Insights
Coronary angioplasty is safe and effective for young patients under 40, showing similar success rates to older patients but with fewer complications. This procedure should be considered a primary treatment option for suitable young individuals.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Younger patients (< or = 40 years) undergoing coronary angioplasty present with distinct risk factor profiles compared to older individuals.
- Key differences include higher rates of male gender, smoking, and subjective stress, alongside lower prevalence of diabetes and hypertension in the younger cohort.
Purpose of the Study:
- To compare the procedural outcomes and long-term results of coronary angioplasty in young patients (< or = 40 years) versus an older patient group (> 40 years).
- To evaluate the safety and efficacy of coronary angioplasty as an initial therapeutic option for young adults with coronary artery disease.
Main Methods:
- Retrospective comparison of 89 young patients (< or = 40 years) with 1,916 older patients (> 40 years) who underwent coronary angioplasty.
- Analysis of procedural success rates, complication rates, long-term follow-up data including survival, need for re-intervention, and subsequent coronary artery bypass grafting.
Main Results:
- Procedural success rates were comparable between young (90%) and older (86%) patients.
- Young patients experienced significantly fewer major complications, with no myocardial infarction, urgent bypass surgery, or mortality, unlike the older group.
- Long-term follow-up showed 100% 5-year survival in young patients, with 5% requiring elective bypass surgery and 34% needing re-angioplasty due to restenosis or disease progression, all successfully managed.
Conclusions:
- Coronary angioplasty is a safe and highly effective procedure for young patients.
- The study supports considering angioplasty as the initial treatment of choice for eligible young patients, emphasizing the importance of concurrent risk factor modification.
Abstract:
Procedural outcome of coronary angioplasty in 89 patients < or = 40 years was compared to an older group of 1,916 patients > 40 years. Young patients were more often male (98% vs. 81%), smokers (89% vs. 70%), and more stressed (subjectively) (29% vs. 15%) compared to the older group. Other coronary risk factors were less common in the younger group: diabetes (5% vs. 13%), and hypertension (19% vs. 40%). Left ventricular function, number of diseased vessels, and the number and location of sites dilated were similar in the two groups. Procedural success rates were similar in the two groups (90% in young, 86% in old; p = NS). Younger patients suffered no major complications of the procedure, in contrast to a myocardial infarction rate of 5%, and urgent bypass surgery and mortality rates of 1% each in the older group. Young patients were followed up for a mean of 30 +/- 26 months after the procedure, with an actuarial 5-year survival of 100%. Four patients (5%) required elective coronary bypass surgery: two due to a failed angioplasty attempt (failure to cross), the other two for progressive multivessel disease. A total of 28 patients (34%) required re-angioplasty (restenosis: 13%, progression elsewhere: 12%, both: 9%). All re-angioplasty procedures were angiographically and clinically successful, with no major complications. For young patients, coronary angioplasty is a safe and effective procedure. If technically feasible, angioplasty should be considered the initial therapeutic option without neglecting risk factor modification.