Department of Cardiology, Alfred Health, Victoria, Australia; Department of Medicine, University of Melbourne, Victoria, Australia; BakerIDI Heart and Diabetes Institute, Melbourne, Victoria, Australia.
Department of Epidemiology and Preventive Medicine, Centre of Cardiovascular Research and Education in Therapeutics (CCRE), Monash University, Victoria, Australia.
Am J Cardiol. 2021 Aug 1;152:19-26. doi: 10.1016/j.amjcard.2021.05.002. Epub 2021 Jun 17.
There is paucity of data examining long-term outcomes of premature coronary artery disease (CAD). We aimed to investigate the short- and long-term clinical outcomes of patients with premature CAD treated by percutaneous coronary intervention (PCI) compared to older cohorts. We analyzed data from 27,869 patients who underwent PCI from 2005-2017 enrolled in a multicenter PCI registry. Patients were divided into three age groups: young group (≤ 45 years), middle-age group (46-65 years) and older group (>65 years). There were higher rates of current smokers in the young (n = 1,711) compared to the middle-age (n = 12,830) and older groups (n = 13,328) (54.2% vs 34.6% vs 11%) and the young presented more frequently with acute coronary syndrome (ACS) (78% vs 66% vs 62%), all p <0.05. There were also greater rates of cardiogenic shock (CS), out-of-hospital cardiac arrest (OHCA) and ST-elevation myocardial infarction (STEMI) in the young, all p <0.05. The young cohort with STEMI had higher rates of in-hospital, 30-day death, and long-term mortality (3.8% vs 0.2%, 4.3% vs 0.2% and 8.6% vs 3.1%, all p <0.05, respectively) compared to the non-STEMI subgroup. There was a stepwise increase in long-term mortality from the young, to middle-age, to the older group (6.1% vs 9.9% vs 26.8%, p <0.001). Younger age was an independent predictor of lower long-term mortality (HR 0.66, 95% CI 0.52-0.84, p = 0.001). In conclusion, younger patients presenting with STEMI had worse prognosis compared to those presenting with non-STEMI. Despite higher risk presentations among young patients, their overall prognosis was favorable compared to older age groups.
目前，关于早发冠心病（CAD）长期预后的数据很少。我们旨在研究与老年患者相比，经皮冠状动脉介入治疗（PCI）治疗的早发 CAD 患者的短期和长期临床结局。我们分析了 2005 年至 2017 年期间在一个多中心 PCI 注册中心接受 PCI 的 27869 名患者的数据。患者被分为三组年龄组：年轻组（≤45 岁）、中年组（46-65 岁）和老年组（>65 岁）。年轻组（n=1711）中，当前吸烟者的比例明显高于中年组（n=12830）和老年组（n=13328）（54.2%比 34.6%比 11%），并且年轻组更常出现急性冠状动脉综合征（ACS）（78%比 66%比 62%），所有 P 值均<0.05。年轻组中也有更高的心源性休克（CS）、院外心脏骤停（OHCA）和 ST 段抬高型心肌梗死（STEMI）的发生率，所有 P 值均<0.05。STEMI 年轻患者的院内、30 天死亡率和长期死亡率均较高（3.8%比 0.2%、4.3%比 0.2%和 8.6%比 3.1%，所有 P 值均<0.05），与非 STEMI 亚组相比。长期死亡率呈阶梯式增加，从年轻组到中年组，再到老年组（6.1%比 9.9%比 26.8%，P<0.001）。年龄较小是长期死亡率较低的独立预测因素（HR 0.66，95%CI 0.52-0.84，P=0.001）。总之，与非 STEMI 患者相比，STEMI 年轻患者的预后更差。尽管年轻患者的风险更高，但与老年组相比，他们的整体预后仍然良好。
