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Coronary Progenitor Cells and Soluble Biomarkers in Cardiovascular Prognosis after Coronary Angioplasty
Published on: January 28, 2020
Long-term follow-up of coronary artery disease presenting in young adults
Jason H Cole1, Joseph I Miller, Laurence S Sperling
1Emory Center for Outcomes Research and Section of Preventive Cardiology, Division of Cardiology, Emory University School of Medicine, Emory University, 1525 Clifton Road, Atlanta, GA 30322, USA.
Insights
Coronary artery disease (CAD) in young adults has a poor prognosis. Key risk factors for mortality include prior myocardial infarction (MI), diabetes, and lower ejection fraction (EF).
Area of Science:
- Cardiology
- Vascular Medicine
- Public Health
Background:
- Coronary artery disease (CAD) is uncommon in individuals under 40.
- Limited data exists on traditional cardiac risk factors in this demographic.
- Understanding long-term outcomes is crucial for this patient group.
Purpose of the Study:
- To evaluate the long-term survival rates of young adults diagnosed with CAD.
- To identify predictors of elevated mortality risk in this population.
Main Methods:
- A cohort of 843 patients under 40 with CAD, diagnosed via coronary angiography (1975-1985), was followed for 15 years.
- Key variables analyzed included prior myocardial infarction (MI), diabetes, heart failure, ejection fraction (EF), and tobacco use.
- Mortality, hypertension, gender, family history, and initial therapy were also assessed.
Main Results:
- Overall 15-year mortality was 30%. Patients with diabetes had 65% mortality, prior MI 45%, and EF <30% had 83% mortality.
- Strong predictors of mortality included prior MI (HR 1.32), New York Heart Association class II heart failure (HR 1.75), and active tobacco use (HR 1.59).
- Revascularization procedures (angioplasty, bypass graft) were associated with lower mortality compared to medical therapy.
Conclusions:
- Coronary artery disease in young adults can lead to a poor long-term prognosis.
- Predictors of significantly higher mortality include prior MI, diabetes, active tobacco abuse, and a lower ejection fraction (EF).
- Aggressive risk factor management and timely revascularization may be critical for improving outcomes.
Objectives:
This study evaluated long-term survival and predictors of elevated risk for young adults diagnosed with coronary artery disease (CAD).
Background:
Coronary artery disease is rarely seen in young adults. Traditional cardiac risk factors have been studied in small series; however, many questions exist.
Methods:
We identified 843 patients under age 40 with CAD diagnosed by coronary angiography from 1975 to 1985. Death, hypertension, gender, family history, prior myocardial infarction (MI), diabetes, heart failure, angina class, number of diseased vessels, ejection fraction (EF), Q-wave infarction, in-hospital death, and initial therapy were studied. Patients were followed for 15 years.
Results:
The mean age was 35 for women (n = 94) and 36 for men (n = 729). The average EF was 55%. Fifty-eight percent of the subjects had single-vessel disease, and 10% were diabetic. The strongest predictors of long-term mortality were a prior MI (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.00 to 1.73), New York Heart Association class II heart failure (HR 1.75, 95% CI 1.03 to 2.97), and active tobacco use (HR 1.59, 95% CI 1.14 to 2.21). Revascularization, rather than medical therapy, was associated with lower mortality (coronary angioplasty: HR 0.51, 95% CI 0.32 to 0.81; coronary artery bypass graft: HR 0.68, 95% CI 0.50 to 0.94). Overall mortality was 30% at 15 years. Patients with diabetes had 15-year mortality of 65%. Those with prior MI had 15-year mortality of 45%, and patients with an EF <30% a mortality of 83% at 15 years.
Conclusions:
Coronary disease in young adults can carry a poor long-term prognosis. A prior MI, diabetes, active tobacco abuse, and lower EF predict a significantly higher mortality.
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