早发冠状动脉疾病对经皮冠状动脉介入治疗后不良事件风险的影响。
Impact of premature coronary artery disease on adverse event risk following percutaneous coronary intervention.
作者信息
Pinxterhuis Tineke H, Ploumen Eline H, Zocca Paolo, Doggen Carine J M, Schotborgh Carl E, Anthonio Rutger L, Roguin Ariel, Danse Peter W, Benit Edouard, Aminian Adel, Hartmann Marc, Linssen Gerard C M, von Birgelen Clemens
机构信息
Department of Cardiology, Thoraxcentrum Twente, Medisch Spectrum Twente, Enschede, Netherlands.
Department of Health Technology and Services Research, Faculty BMS, Technical Medical Centre, University of Twente, Enschede, Netherlands.
出版信息
Front Cardiovasc Med. 2023 Sep 7;10:1160201. doi: 10.3389/fcvm.2023.1160201. eCollection 2023.
OBJECTIVES
We assessed differences in risk profile and 3-year outcome between patients undergoing percutaneous coronary intervention (PCI) for and coronary artery disease (CAD).
BACKGROUND
The prevalence of CAD increases with age, yet some individuals develop obstructive CAD at younger age.
METHODS
Among participants in four randomized all-comers PCI trials, without previous coronary revascularization or myocardial infarction (MI), we compared patients with premature (men <50 years; women <55 years) and non-premature CAD. Various clinical endpoints were assessed, including multivariate analyses.
RESULTS
Of 6,171 patients, 887 (14.4%) suffered from premature CAD. These patients had fewer risk factors than patients with non-premature CAD, but were more often smokers (60.7% vs. 26.4%) and overweight (76.2% vs. 69.8%). In addition, premature CAD patients presented more often with ST-segment elevation MI and underwent less often treatment of multiple vessels, and calcified or bifurcated lesions. Furthermore, premature CAD patients had a lower all-cause mortality risk (adj.HR: 0.23, 95%-CI: 0.10-0.52; < 0.001), but target vessel revascularization (adj.HR: 1.63, 95%-CI: 1.18-2.26; = 0.003) and definite stent thrombosis risks (adj.HR: 2.24, 95%-CI: 1.06-4.72; = 0.034) were higher. MACE rates showed no statistically significant difference (6.6% vs. 9.4%; adj.HR: 0.86, 95%-CI: 0.65-1.16; = 0.33).
CONCLUSIONS
About one out of seven PCI patients was treated for premature CAD. These patients had less complex risk profiles than patients with non-premature CAD; yet, their risk of repeated revascularization and stent thrombosis was higher. As lifetime event risk of patients with premature CAD is known to be particularly high, further efforts should be made to improve modifiable risk factors such as smoking and overweight.
TWENTE TRIALS
(TWENTE I, clinicaltrials.gov: ), DUTCH PEERS (TWENTE II, ), BIO-RESORT (TWENTE III, ), and BIONYX (TWENTE IV, ).
目的
我们评估了因稳定型和急性冠状动脉疾病（CAD）接受经皮冠状动脉介入治疗（PCI）的患者在风险特征和3年预后方面的差异。
背景
CAD的患病率随年龄增长而增加，但一些个体在年轻时就发展为阻塞性CAD。
方法
在四项随机的全人群PCI试验的参与者中，这些参与者既往无冠状动脉血运重建或心肌梗死（MI），我们比较了患有早发性（男性<50岁；女性<55岁）和非早发性CAD的患者。评估了各种临床终点，包括多变量分析。
结果
在6171例患者中，887例（14.4%）患有早发性CAD。这些患者的危险因素比非早发性CAD患者少，但吸烟者更多（60.7%对26.4%）且超重者更多（76.2%对69.8%）。此外，早发性CAD患者更常表现为ST段抬高型MI，且多支血管、钙化或分叉病变的治疗频率较低。此外，早发性CAD患者的全因死亡风险较低（调整后HR：0.23，95%CI：0.10 - 0.52；P<0.001），但靶血管血运重建（调整后HR：1.63，95%CI：1.18 - 2.26；P = 0.003）和明确的支架血栓形成风险（调整后HR：2.24，95%CI：1.06 - 4.72；P = 0.034）较高。主要不良心血管事件（MACE）发生率无统计学显著差异（6.6%对9.4%；调整后HR：0.86，95%CI：0.65 - 1.16；P = 0.33）。
结论
约七分之一的PCI患者因早发性CAD接受治疗。这些患者的风险特征比非早发性CAD患者的风险特征简单；然而，他们再次血运重建和支架血栓形成的风险较高。由于已知早发性CAD患者的终生事件风险特别高，应进一步努力改善可改变的危险因素，如吸烟和超重。
特温特试验
（特温特I，clinicaltrials.gov： ），荷兰同行试验（特温特II， ），生物度假村试验（特温特III， ），以及生物尼克斯试验（特温特IV， ）。
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