Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients

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• 作者：Sara Roversi ; Giuseppe Biondi-Zoccai ; Enrico Romagnoli ; Imad Sheiban ; Stefano De Servi ; Corrado Tamburino ; Antonio Colombo ; Francesco Burzotta ; Patrizia Presbitero ; Leonardo Bolognese ; Leonardo Paloscia ; Paolo Rubino ; Gennaro Sardella ; Carlo Briguori ; Luigi Niccoli ; Gianfranco Franco ; Domenico Di Girolamo ; Luigi Piatti ; Cesare Greco ; Sonia Petronio ; et al.
• 关键词：Age ; Bifurcation ; Coronary artery disease ; Percutaneous transluminal coronary angioplasty ; Stent
• 刊名：International Journal of Cardiology
• 出版年：2013
• 出版时间：10 September, 2013
• 年：2013
• 卷：167
• 期：6
• 页码：2995-2999
• 全文大小：191 K

文摘

Background

Coronary artery disease is most common in older patients, but may occur in younger subjects. The outlook of young patients after percutaneous coronary intervention (PCI) of challenging lesion subsets such as coronary bifurcations, is not established. We thus aimed to appraise the early and long-term results of PCI for bifurcations in young patients.

Methods

A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between 2002 and 2006 in 22 Italian centers. Patients were divided in 2 groups: age ¡Ü 45 years, and age > 45 years. The primary end-point was long-term rate of major adverse cardiac events (MACE).

Results

4,314 patients were included: 195 (4.5 % ) in the younger group, and 4119 (95.5 % ) in the older group. 30-day outcomes did not show significant differences in MACE rates, with 1.0 % in the ¡Ü 45 years group and 2.1 % in the > 45 years group (p = 0.439), with death in 0.5 % and 1.2 % (p = 0.388). At long-term follow-up (24.4 ¡À 15.1 months), younger patients showed similar rates of MACE, (12.8 % vs. 16.6 % , p = 0.161), myocardial infarction (3.1 % vs. 3.7 % , p = 0.633), target lesion revascularization (11.3 % vs. 12.5 % , p = 0.627), or stent thrombosis (1.5 % vs. 2.8 % , p = 0.294), despite an increased risk of death in older patients (1.0 % vs. 5.0 % , p = 0.012). Even at extensive multivariable analysis, younger patients still faced a similar risk of MACE (HR = 0.78 [0.48-1.27], p = 0.318).

Conclusions

Despite their low age, young patients undergoing PCI for bifurcation face a significant risk of early and late non-fatal adverse events. Thus, they should not be denied careful medical management and follow-up.