Key result
Dyslipidaemia is linked to ~3.8-fold higher post-PCI MACE in premature CAD.
Why the study?
Baseline predictors of MACE after PCI in premature CAD remain poorly characterised in Asian practice, and it was uncertain whether a stricter Asia Pacific age band discriminates risk within the premature range.
Do baseline clinical factors and a stricter Asia Pacific age band predict major adverse cardiovascular events after percutaneous coronary intervention in patients with premature coronary artery disease?
Cohort (n=318)
No
Do baseline clinical factors and a stricter Asia Pacific age band predict major adverse cardiovascular events after percutaneous coronary intervention in patients with premature coronary artery disease?
In Indonesian patients with premature coronary artery disease undergoing PCI, dyslipidaemia and LVEF <40% strongly predict MACE, whereas stricter age stratification within the premature range does not improve risk discrimination.
Should not yet change practice in premature CAD; hypothesis-generating for LVEF-guided trials.
Background: Premature coronary artery disease (PCAD) is increasingly recognised in Asian percutaneous coronary intervention (PCI) practice, yet baseline predictors of major adverse cardiovascular events (MACE) after revascularisation remain poorly characterised. Objective: To identify independent baseline predictors of MACE after PCI in PCAD and determine whether a stricter "Asia Pacific" age band discriminates risk within the premature range. Methods: Retrospective cohort study at a tertiary PCI centre in Malang, Indonesia (January 2022–March 2025; follow-up censored 1 May 2026). Patients meeting 2019 ACC/AHA PCAD criteria (men <55 years or women <65 years) with confirmed obstructive coronary artery disease (CAD) treated by PCI were enrolled. The primary outcome was composite MACE (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, heart-failure hospitalisation, or unplanned revascularisation), assessed by cause-specific Cox proportional-hazards regression. Result: Among 318 patients who completed follow-up (median age 50 years; 31.4% women; median follow-up 930.5 days), 41 MACE events occurred (12.9%). MACE incidence was similar between Asia Pacific PCAD (n=159; 11.3%) and Older PCAD (n=159; 14.5%; 3-year cumulative incidence 12.0% vs 16.9%; log-rank p=0.308). Reduced left ventricular ejection fraction (LVEF <40%) and dyslipidaemia were independent baseline predictors (LVEF <40%: adjusted HR 1.79, 95% CI 1.09–2.95; dyslipidaemia: adjusted HR 3.84, 95% CI 2.09–7.07; C=0.717, bootstrap-corrected C=0.715 (1000 resamples; optimism +0.002)). Conclusion: Reduced LVEF and dyslipidaemia were the principal baseline predictors of MACE in this Indonesian single-centre PCAD post-PCI cohort; age stratification within the premature range did not discriminate risk. Results should be interpreted in the context of 29.3% loss to follow-up and single-centre design.
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Baskoro et al. (2026) conducted a cohort in Premature coronary artery disease (PCAD) treated by percutaneous coronary intervention (PCI) (n=318). Baseline clinical predictors (dyslipidaemia, reduced LVEF <40%) and Asia Pacific PCAD age band vs. Absence of risk factors / Older PCAD age band was evaluated on Composite MACE (cardiovascular death, non-fatal myocardial infarction, non-fatal stroke, heart-failure hospitalisation, or unplanned revascularisation) (HR 3.84, 95% CI 2.09-7.07, p=0.308). Dyslipidaemia (HR 3.84, 95% CI 2.09–7.07) and LVEF <40% (HR 1.79, 95% CI 1.09–2.95) predicted post-PCI MACE in premature CAD, whereas age stratification did not (11.3% vs 14.5%, p=0.308).
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