Long-Term Prognosis in Young Patients with Acute Coronary Syndrome Treated with Percutaneous Coronary Intervention

• Main Authors: Yagel O, Shadafny N, Eliaz R, Dagan G, Leibowitz D, Tahiroglu I, Planer D, Amir O, Elbaz Greener G, Alcalai R
• Format: Article
• Language: English
• Published: Dove Medical Press 2021-04-01
• Series: Vascular Health and Risk Management
• Subjects: acute coronary syndrome; acs; nstemi; stemi; young population; outcomes
• Online Access: https://www.dovepress.com/long-term-prognosis-in-young-patients-with-acute-coronary-syndrome-tre-peer-reviewed-fulltext-article-VHRM

Oren Yagel,* Naseem Shadafny,* Ran Eliaz, Gil Dagan, David Leibowitz, Ilgar Tahiroglu, David Planer, Offer Amir, Gabby Elbaz Greener,* Ronny Alcalai* Department of Cardiology, Hadassah Medical Center, Jerusalem, Israel; Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel*These authors contributed equally to this workCorrespondence: Gabby Elbaz GreenerHadassah Medical Center, Cardiology Division, Room Number 114, Jerusalem, IsraelTel [phone]Fax [phone]Email [e-mail]: Acute coronary syndrome (ACS) at a young age is uncommon. Limited data regarding the long-term follow-up and prognosis in this population are available. Our objectives were to evaluate the long-term clinical outcomes of patients presenting with ACS at a young age and to assess factors that predict long-term prognosis.Methods: A retrospective analysis of consecutive young patients (male below 40 and female below 50 years old) that were admitted with ACS and underwent percutaneous coronary intervention (PCI) between the years 1997 and 2009. Demographics, clinical characteristics, and clinical outcomes including major cardiovascular (CV) events and mortality were analyzed. Multivariable cox proportional hazard model was performed to identify predictors of long-term prognosis.Results: One-hundred sixty-five patients were included with a mean follow-up of 9.1± 4.6 years. Most patients were men (88%), and mean age (years) was 36.8± 4.2. During follow-up, 15 (9.1%) died, 98 (59.4%) patients had at least one major CV event, 22 (13.3%) patients had more than two CV events, and the mean number of recurrent CV events was 1.4± 1.48 events per patient. In multivariate analysis, the strongest predictors of major CV events and/or mortality were coronary intervention without stent insertion (HR1.77; 95% CI 1.09– 2.9), LAD artery involvement (HR 1.59; 95% CI 1.04– 2.44) and hypertension (HR 1.6; 95% CI 1.0– 2.6).Conclusion: Patients with ACS in young age are at high risk for major CV and/or mortality in long-term follow-up with a high rate of recurrent CV events. Close follow-up and risk factor management for secondary prevention have a major role, particularly in this population.Keywords: acute coronary syndrome, ACS, NSTEMI, STEMI, young population, outcomes