Early Intervention in Younger Patients With CAD Benefits Long-Term Prognosis

December 31, 2020
Samantha DiGrande

Premature coronary artery disease (CAD) is an aggressive disease with a high rate of ischemic recurrences and premature death, researchers said.

Recent research has found that there has been an increase in younger patients admitted to hospitals for premature myocardial infarction, specifically in women younger than 50 years of age, for whom the incidence has almost doubled in the past 20 years. Though past studies have identified a link between risk factors such as active smoking, ethnicity or inflammation on the prognosis of patients with premature coronary artery disease (CAD), more research is necessary to fully understand the implications these risks could have long-term.

Researchers utilized the Duke Databank for Cardiovascular Disease in a recent study in order to describe the baseline and follow-up risk factors of patients in this age bracket admitted with premature CAD and to evaluate their long-term prognosis.

The primary objective of this retrospective, observational study was to determine the rate of major adverse cardiovascular events (MACEs), defined as the composite of all-cause death, nonfatal myocardial infarction, revascularization by percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG) or stroke for up to 10 years of follow-up.

From 1995 to 2013 there were 3655 patients under 50 years of age admitted to the hospital for a first manifestation of obstructive CAD. The median age of these patients was 45 years (interquartile range 41 to 47 years); 27.5% were women, 26.0% were Black, and 6.5% presented before age 35. The study found that nearly 73% had at least 2 cardiovascular risk factors and 43% had ≥3. The most frequent risk factor was active or prior smoking (60.8%), followed by hypertension (52.8%), family history of CAD (39.8%), and diabetes (23.8%).

By the 10th year of follow up, 52.9% of patients had developed at least 1 recurrent ischemic event, recurrent myocardial infarction, revascularization, or stroke. The most frequent first event after premature CAD onset were follow-up revascularization PCI or CABG (15.3% and 6.3%, respectively), recurrent myocardial infarction (14.4%), or death (13.4%). In 3.5% of patients, stroke was the first event.

The authors found that women with premature CAD were at a higher risk of a subsequent ischemic event compared with men (adjusted HR, 1.15; 95% CI, 1.03–1.28; P = .01). Though infrequently observed, chronic inflammatory disease was strongly associated with a first ischemic recurrence (adjusted HR, 1.61; 95% CI, 1.23–2.11; P < .001).

The investigators concluded that premature CAD is an aggressive disease with a high rate of ischemic recurrences and premature death. Younger individuals were found to have a high proportion of adjustable cardiovascular risk factors, leading the study authors to emphasize the importance of implementing early, multimodal, and innovative prevention strategies for younger patients both in primary and secondary prevention tactics.

Reference

Zeitouni M, Clare R, Chiswell K, et al. Risk factor burden and long-term prognosis of patients with premature coronary artery disease. J Am Heart Assoc. Published online December 8, 2020. doi: 10.1161/JAHA.120.017712