NEW YORK (Reuters Health) – Young adults who received coronary artery stents through age 40 had excellent short- and longer-term results, and the Italian researchers who reported this finding say the devices should be the treatment of choice in this age group.
“PCI in patients age 40 or younger is very uncommon, approximately 2 to 3% of all PCIs performed in our area,” Dr. Emanuele Meliga of Mauriziano Hospital in Turin told Reuters Health by e-mail.
Young people with coronary artery disease (CAD) requiring intervention often have multiple cardiovascular risk factors, such as hypertension, dyslipidemia, diabetes, a family history of coronary artery disease and, above all, smoking, he said.
In a report online March 22 in the American Journal of Cardiology, Dr. Meliga and his colleagues noted that CAD in younger patients is very often untreated because it’s unrecognized. Roughly 60% of patients in this study, for example, had hypertension and/or hypercholesterolemia, but at the time of hospital admission, fewer than 5% were receiving lipid-lowering agents or antihypertensive drugs.
The findings are drawn from registry data on 214 consecutive patients (88% men) who underwent coronary angiography with stent implantation at one of five tertiary care centers between 2005 and 2010.
The average age was 36 years, 77% were active smokers, and the most common clinical presentation was ST-segment elevation myocardial infarction (57%).
Across the cohort, patients received a total of 272 stents (154 bare metal and 118 drug-eluting).
The rate of in-hospital major adverse cardiac and cerebrovascular events was 2.3%; there were no in-hospital deaths.
With a median follow-up of 757 days, the overall mortality rate was 0.9%, the incidence of myocardial infarction was 3.7%, and 12.6% of patients required a new revascularization procedure (target vessel revascularization 6.5%, percutaneous intervention in another vessel 4.7%, and coronary artery bypass grafting 1.4%).
On multivariate analysis, active smoking and left ventricular ejection fraction less than 50% were independent predictors of major adverse cardiac and cerebrovascular events.
In contrast to the marked undertreatment of the study patients prior to hospitalization, medical treatment afterward played “a significant role in the excellent clinical outcomes reported in the present study,” the authors wrote.
At discharge, all patients received aspirin and clopidogrel, 90% were prescribed statins, and 70% were prescribed beta-blockers and angiotensin-converting enzyme inhibitors. All patients were prescribed at least one antihypertensive drug.
Am J Cardiol 2012.