Premature CAD in first MI patients treated with contemporary stents was associated with lower 1-year MACE compared to non-premature CAD (adjusted HR 0.50; 95% CI 0.26-0.96; P=0.037).
Cohort (n=3,323)
Yes
Does premature CAD compared to non-premature CAD affect clinical outcomes in patients with a first MI treated with new-generation drug-eluting stents?
Patients with premature CAD presenting with a first MI and treated with contemporary stents have lower rates of MACE and mortality compared to those with non-premature CAD, likely due to a lower baseline risk profile.
Effect estimate: adjusted HR 0.50 (95% CI 0.26-0.96)
p-value: p=0.037
AIMS: Patients with premature coronary artery disease (CAD) have a higher incidence of myocardial infarction (MI) than patients with non-premature CAD. The aim of the present study is to asess differences in clinical outcome after a first acute MI, percutaneously treated with new-generation drug-eluting stents between patients with premature and non-premature CAD. METHODS AND RESULTS: We pooled and analysed the characteristics and clinical outcome of all patients with a first MI (and no previous coronary revascularization) at time of enrolment, in four large-scale drug-eluting stent trials. Coronary artery disease was classified premature in men aged <50 and women <55 years. Myocardial infarction patients with premature and non-premature CAD were compared. The main endpoint was major adverse cardiac events (MACE): all-cause mortality, any MI, emergent coronary artery bypass surgery, or clinically indicated target lesion revascularization. Of 3323 patients with a first MI, 582 (17.5%) had premature CAD. These patients had lower risk profiles and underwent less complex interventional procedures than patients with non-premature CAD. At 30-day follow-up, the rates of MACE [hazard ratio (HR): 0.22, 95% confidence interval (CI): 0.07-0.71; P = 0.005), MI (HR: 0.22, 95% CI: 0.05-0.89; P = 0.020), and target vessel failure (HR: 0.30, 95% CI: 0.11-0.82; P = 0.012) were lower in patients with premature CAD. At 1 year, premature CAD was independently associated with lower rates of MACE (adjusted HR: 0.50, 95% CI: 0.26-0.96; P = 0.037) and all-cause mortality (adjusted HR: 0.24, 95% CI: 0.06-0.98; P = 0.046). At 2 years, premature CAD was independently associated with lower mortality (adjusted HR: 0.16, 95% CI: 0.05-0.50; P = 0.002). CONCLUSIONS: First MI patients with premature CAD, treated with contemporary stents, showed lower rates of MACE and all-cause mortality than patients with non-premature CAD, which is most likely related to differences in cardiovascular risk profile. TWENTE trials: TWENTE I, clinicaltrials.gov: NCT01066650), DUTCH PEERS (TWENTE II, NCT01331707), BIO-RESORT (TWENTE III, NCT01674803), and BIONYX (TWENTE IV, NCT02508714).
Pinxterhuis et al. (Tue,) conducted a cohort in First acute myocardial infarction (n=3,323). Premature CAD (men <50 and women <55 years) vs. Non-premature CAD was evaluated on Major adverse cardiac events (MACE): all-cause mortality, any MI, emergent coronary artery bypass surgery, or clinically indicated target lesion revascularization at 1 year (adjusted HR 0.50, 95% CI 0.26-0.96, p=0.037). Premature CAD in first MI patients treated with contemporary stents was associated with lower 1-year MACE compared to non-premature CAD (adjusted HR 0.50; 95% CI 0.26-0.96; P=0.037).