Department of Medicine, Mayo Clinic, Rochester, MN, USA.
Am J Cardiol. 2011 Mar 1;107(5):668-74. doi: 10.1016/j.amjcard.2010.10.044. Epub 2011 Jan 17.
Little is known regarding temporal trends in characteristics and outcomes of young (≤50 years) patients who develop symptomatic premature coronary artery disease (CAD). The aim of this study was to describe temporal trends in clinical characteristics and outcomes and gender differences in patients with premature CAD undergoing percutaneous coronary intervention (PCI) over 3 decades. A retrospective analysis of 2,922 consecutive patients ≤50 years of age undergoing PCI from 1980 through 2007 was conducted. Baseline characteristics and in-hospital and long-term outcomes were compared by decade. Gender differences and predictors of mortality were analyzed in the most recent cohort. Although most patients were men (80%), there was an increasing proportion of women over time. An increasing prevalence of diabetes mellitus (10% in 1980 to 1989, 16% in 1990 to 1999, 20% in 2000 to 2007, p <0.001), hypertension (29%, 41%, 57%, p <0.001), and hyperlipidemia (39%, 55%, 73%, p <0.001) coincided with increasing body mass index (28.2 ± 4.6, 29.9 ± 5.8, 30.9 ± 6.7 kg/m(2), p <0.001). The proportion of smokers decreased (84%, 76%, 74%, p <0.001). In-hospital mortality (1.0%, 0.8%, 0.9%, p = 0.93) and long-term mortality at 5 years (6%, 6%, 7%, p = 0.97) did not change over time. In contemporary PCI practice, women with premature CAD were more likely to have diabetes mellitus (25% vs 19%, p = 0.02), single-vessel disease (56% vs 41%, p <0.001), and a bleeding complication. In conclusion, there is an increasing burden of cardiovascular risk factors, related mostly to obesity, in patients with premature CAD requiring PCI. Long-term morbidity or mortality in these patients has not improved over the previous 3 decades.
关于发生有症状的早发冠心病（CAD）的年轻（≤50 岁）患者的特征和结局的时间趋势，人们知之甚少。本研究的目的是描述在过去 3 个十年中接受经皮冠状动脉介入治疗（PCI）的早发 CAD 患者的临床特征和结局的时间趋势以及性别差异。对 1980 年至 2007 年期间连续接受 PCI 的 2922 名≤50 岁的患者进行了回顾性分析。按十年比较基线特征、住院和长期结局。在最近的队列中分析了性别差异和死亡率的预测因素。尽管大多数患者为男性（80%），但随着时间的推移，女性的比例逐渐增加。糖尿病（1980-1989 年 10%，1990-1999 年 16%，2000-2007 年 20%，p<0.001）、高血压（29%、41%、57%，p<0.001）和高血脂（39%、55%、73%，p<0.001）的患病率增加，同时体重指数（28.2±4.6、29.9±5.8、30.9±6.7 kg/m2，p<0.001）也有所增加。吸烟者的比例下降（84%、76%、74%，p<0.001）。住院死亡率（1.0%、0.8%、0.9%，p=0.93）和 5 年的长期死亡率（6%、6%、7%，p=0.97）在不同时期没有变化。在当代 PCI 实践中，早发 CAD 的女性更有可能患有糖尿病（25%比 19%，p=0.02）、单支血管疾病（56%比 41%，p<0.001）和出血并发症。总之，在需要 PCI 的早发 CAD 患者中，心血管危险因素的负担越来越大，主要与肥胖有关。这些患者的长期发病率或死亡率在过去 30 年中并未改善。
