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Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
Percutaneous coronary intervention in patients aged ≤40 years: a 10-year single-centre cohort study
Lining Liang1, Chunsong Wang1, Huawei Dong1
1Department of Cardiology, Liaocheng People's Hospital, Liaocheng, Shandong, China.
Insights
Percutaneous coronary intervention (PCI) in young adults shows complex anatomy but low cardiac mortality. Key risks for adverse events include diabetes, complex coronary artery disease, and short-term antiplatelet therapy.
Area of Science:
- Cardiology
- Interventional Cardiology
- Vascular Medicine
Background:
- Coronary artery disease (CAD) is rising in adults ≤40 years.
- Long-term outcomes after percutaneous coronary intervention (PCI) with drug-eluting stents (DES) in this population are not well-defined.
Purpose of the Study:
- To identify procedural patterns in young adults undergoing PCI.
- To determine prognostic factors for long-term outcomes in this cohort.
Main Methods:
- Retrospective single-centre cohort study of 312 patients aged ≤40 years undergoing PCI for de novo lesions.
- Data collected included baseline characteristics, quantitative coronary angiography, and procedural details.
- Major adverse cardiovascular and cerebrovascular events (MACCE) were the primary endpoint; Cox regression identified predictors.
Main Results:
- Procedural success was high (98.4%) with frequent DES use (93.9%) and radial access (85.9%).
- Over a median of 5.2 years, MACCE occurred at 14.2% cumulative incidence (5-year).
- Independent predictors of MACCE included diabetes, high SYNTAX score (≥23), and dual antiplatelet therapy duration <12 months.
Conclusions:
- Young adults undergoing PCI present with complex coronary artery disease but experience low cardiac mortality.
- Diabetes, angiographic complexity, and abbreviated antiplatelet therapy are significant drivers of adverse cardiovascular events.
- Intensive preventive strategies and optimized antiplatelet therapy are crucial for this patient group.
Background:
Coronary artery disease (CAD) in adults aged ≤40 years is increasing, yet long-term outcomes after percutaneous coronary intervention (PCI) in the drug-eluting stent (DES) era remain unclear. We aimed to identify procedural patterns and prognostic factors in this very young cohort.
Methods:
This single-centre retrospective cohort study included 312 consecutive patients aged ≤40 years who underwent successful PCI for de novo lesions (≥70% stenosis) between 2014 and 2024. Baseline characteristics, quantitative coronary angiography, and procedural data were collected. The primary endpoint was major adverse cardiovascular and cerebrovascular events (MACCE). Cox regression identified independent predictors.
Results:
Patients were 82% men (mean age 36.8 ± 4.9 years) with a median SYNTAX score of 16. Procedural success was 98.4% with 93.9% DES implantation and 85.9% radial access. Over 1,620 patient-years (median 5.2 years), MACCE occurred at 27.8 per 1,000 patient-years (5-year cumulative 14.2%). Cardiac mortality was 3.7 per 1,000 patient-years. Diabetes [adjusted hazard ratios (HR) 1.78, 95% confidence interval (CI) 1.06-2.99], SYNTAX score ≥23 (HR 2.01, 1.19-3.40), and dual antiplatelet therapy <12 months (HR 1.62, 1.00-2.64) independently predicted MACCE.
Conclusions:
Young adults undergoing PCI exhibit complex anatomy but low cardiac mortality. Diabetes, angiographic complexity, and abbreviated antiplatelet therapy are key drive of adverse events, warranting intensive prevention and optimised antiplatelet strategies.
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