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Characteristics and in-hospital outcomes in young patients presenting with acute coronary syndrome treated by percutaneous coronary intervention

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Abstract

There is a growing interest in the optimizing care of acute coronary syndrome (ACS) in young patients, largely owing to their potential for longer life expectancy. Herein, we aimed to investigate the clinical characteristics and outcome of young ACS patients (e.g. under 60 year old) from a Japanese multicenter percutaneous coronary intervention (PCI) registry (KiCS-PCI). KiCS-PCI registered consecutive ACS patients from 15 institutions, and 1560 (24.0%) out of 6499 ACS-related PCI involved patients aged <60 years. In this group, prevalence of dyslipidemia, smoking and family history of premature coronary artery disease (CAD) was higher, while the other classical risk factors were lower when compared to the old patients. After adjustment for known confounders, presentation with cardiogenic shock (CS) before PCI (OR 32.57, 95% CI 12.06–87.97), culprit lesion of LMT (OR 7.53, 95% CI 1.26–44.98), multi-vessel disease (OR 3.82, 95% CI 1.37–10.63) and higher body mass index (OR 1.12, 95% CI 1.00–1.24) showed association with higher in-hospital mortality in young patients. Multi-vessel disease (OR 4.1, 95% CI 1.9–8.9) and chronic kidney disease (OR 3.56, 95% CI 2.26–5.68) were associated with CS presentation. CS presentation was inversely associated with classical risk factors such as hypertension (OR 0.61, 95% CI 0.38–0.96), family history of CAD (OR 0.49, 95% CI 0.25–0.96), and dyslipidemia (OR 0.45, 95% CI 0.29–0.71) and culprit lesion of RCA (OR 0.60, 95% CI 0.37–0.94). Overall, ACS in the younger population was observed frequently, accounting for a quarter of ACS-related PCI. CS was a harbinger for in-hospital mortality in these patients.

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References

  1. Esteban MR, Montero SM, Sánchez JJ, Hernández HP, Pérez JJ, Afonso JH, Pérez DC, Díaz BB, de León AC. Acute coronary syndrome in the young: clinical characteristics, risk factors and prognosis. Open Cardiovasc Med J. 2014;8:61–7.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Panduranga P, Sulaiman K, Al-Zakwani I, Abdelrahman S. Acute coronary syndrome in young adults from oman: results from the gulf registry of acute coronary events. Heart Views. 2010;11:93–8.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Chen TS, Incani A, Butler TC, Poon K, Fu J, Savage M, Dahl M, Callow DE, Colburn D, Hammett C, Walters DL. The demographic profile of young patients (<45 years-old) with acute coronary syndromes in Queensland. Heart Lung Circ. 2014;23:49–55.

    Article  PubMed  Google Scholar 

  4. Furukawa Y, Ehara N, Taniguchi R, Haruna Y, Ozasa N, Saito N, Doi T, Hoshino K, Tamura T, Shizuta S, Abe M, Toma M, Morimoto T, Teramukai S, Fukushima M, Kita T, Kimura T, Investigators C-K. Coronary risk factor profile and prognostic factors for young Japanese patients undergoing coronary revascularization. Circ J. 2009;73:1459–65.

    Article  PubMed  Google Scholar 

  5. O’Gara PT, Kushner FG, Ascheim DD, Casey DE, Chung MK, de Lemos JA, Ettinger SM, Fang JC, Fesmire FM, Franklin BA, Granger CB, Krumholz HM, Linderbaum JA, Morrow DA, Newby LK, Ornato JP, Ou N, Radford MJ, Tamis-Holland JE, Tommaso CL, Tracy CM, Woo YJ, Zhao DX, Anderson JL, Jacobs AK, Halperin JL, Albert NM, Brindis RG, Creager MA, DeMets D, Guyton RA, Hochman JS, Kovacs RJ, Ohman EM, Stevenson WG, Yancy CW, Physicians ACoE, Interventions SfCAa. ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;2013(61):e78–140.

    Article  Google Scholar 

  6. Matsuo S, Imai E, Horio M, Yasuda Y, Tomita K, Nitta K, Yamagata K, Tomino Y, Yokoyama H, Hishida A. Collaborators developing the Japanese equation for estimated GFR. Revised equations for estimated GFR from serum creatinine in Japan. Am J Kidney Dis. 2009;53(6):982–92.

    Article  CAS  PubMed  Google Scholar 

  7. Mehran R, Rao SV, Bhatt DL, Gibson CM, Caixeta A, Eikelboom J, Kaul S, Wiviott SD, Menon V, Nikolsky E, Serebruany V, Valgimigli M, Vranckx P, Taggart D, Sabik JF, Cutlip DE, Krucoff MW, Ohman EM, Steg PG, White H. Standardized bleeding definitions for cardiovascular clinical trials: a consensus report from the Bleeding Academic Research Consortium. Circulation. 2011;123:2736–47.

    Article  PubMed  Google Scholar 

  8. Brindis RG, Fitzgerald S, Anderson HV, Shaw RE, Weintraub WS, Williams JF. The American College of Cardiology–National Cardiovascular Data Registry (ACC-NCDR): building a national clinical data repository. J Am Coll Cardiol. 2001;37:2240–5.

    Article  CAS  PubMed  Google Scholar 

  9. Karim MA, Majumder AA, Islam KQ, Alam MB, Paul ML, Islam MS, Chowdhury KN, Islam SM. Risk factors and in-hospital outcome of acute ST segment elevation myocardial infarction in young Bangladeshi adults. BMC Cardiovasc Disord. 2015;15:73.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Hochman JS, Sleeper LA, Webb JG, Sanborn TA, White HD, Talley JD, Buller CE, Jacobs AK, Slater JN, Col J, McKinlay SM, LeJemtel TH. Early revascularization in acute myocardial infarction complicated by cardiogenic shock. SHOCK Investigators. Should we emergently revascularize occluded coronaries for cardiogenic shock. N Engl J Med. 1999;341:625–34.

    Article  CAS  PubMed  Google Scholar 

  11. Demondion P, Fournel L, Golmard JL, Niculescu M, Pavie A, Leprince P. Predictors of 30-day mortality and outcome in cases of myocardial infarction with cardiogenic shock treated by extracorporeal life support. Eur J Cardiothorac Surg. 2014;45:47–54.

    Article  PubMed  Google Scholar 

  12. Aissaoui N, Puymirat E, Tabone X, Charbonnier B, Schiele F, Lefèvre T, Durand E, Blanchard D, Simon T, Cambou JP, Danchin N. Improved outcome of cardiogenic shock at the acute stage of myocardial infarction: a report from the USIK 1995, USIC 2000, and FAST-MI French nationwide registries. Eur Heart J. 2012;33:2535–43.

    Article  PubMed  Google Scholar 

  13. Kohsaka S, Miyata H, Ueda I, Masoudi FA, Peterson ED, Maekawa Y, Kawamura A, Fukuda K, Roe MT, Rumsfeld JS, NCDR J-Ka. An international comparison of patients undergoing percutaneous coronary intervention: a collaborative study of the National Cardiovascular Data Registry (NCDR) and Japan Cardiovascular Database-Keio interhospital Cardiovascular Studies (JCD-KiCS). Am Heart J. 2015;170:1077–85.

    Article  PubMed  Google Scholar 

  14. Inohara T, Kohsaka S, Goto M, Furukawa Y, Fukushima M, Sakata R, Elayda M, Wilson JM, Kimura T. Hypothesis of long-term outcome after coronary revascularization in Japanese patients compared to multiethnic groups in the US. PLoS One. 2015;10:e0128252.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Wang TY, Newby LK, Chen AY, Mulgund J, Roe MT, Sonel AF, Bhatt DL, DeLong ER, Ohman EM, Gibler WB, Peterson ED. Hypercholesterolemia paradox in relation to mortality in acute coronary syndrome. Clin Cardiol. 2009;32(9):E22–8. doi:10.1002/clc.20518.

    Article  PubMed  Google Scholar 

  16. Spencer FA, Allegrone J, Goldberg RJ, Gore JM, Fox KA, Granger CB, Mehta RH, Brieger D, GRACE Investigators. Association of statin therapy with outcomes of acute coronary syndromes: the GRACE study. Ann Intern Med. 2004;140(11):857–66.

    Article  PubMed  Google Scholar 

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Acknowledgements

This research was supported by a grant from the Ministry of Education, Culture, Sports, Science, and Technology, Japan [KAKENHI Nos. 16H05215, 25460630 (S.K.) and 25460777 (I.U.)] and by Grants-in-Aid for Scientific Research from the Japan Society for the Promotion of Science.

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Authors and Affiliations

  1. Department of Cardiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, Japan

    Yukiho Hirota, Mitsuaki Sawano, Ikuko Ueda, Kentaro Hayashida, Shinsuke Yuasa, Yuichiro Maekawa, Shun Kohsaka & Keiichi Fukuda

  2. Department of Cardiology, Ashikaga Red Cross Hospital, Tochigi, Japan

    Yohei Numasawa

  3. Department of Cardiology, Saiseikai Utsunomiya Hospital, Tochigi, Japan

    Shigetaka Noma

  4. Department of Cardiology, National Hospital Organization, Saitama National Hospital, Saitama, Japan

    Masahiro Suzuki

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  1. Yukiho Hirota
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  2. Mitsuaki Sawano
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  3. Yohei Numasawa
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  4. Ikuko Ueda
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  5. Shigetaka Noma
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  6. Masahiro Suzuki
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  7. Kentaro Hayashida
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  8. Shinsuke Yuasa
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  9. Yuichiro Maekawa
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  10. Shun Kohsaka
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  11. Keiichi Fukuda
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Contributions

YH, SK, and IU conceived and designed the research, and drafted the manuscript. YH, SK, and HM analyzed and interpreted the data. HM performed the statistical analysis. SK and KF handled funding and supervision; JF, MS, YS, YN, KN, IN, YYM, and KF made critical revisions of the manuscript for important intellectual content.

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Correspondence to Shun Kohsaka.

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The authors declare that they have no competing interests.

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Hirota, Y., Sawano, M., Numasawa, Y. et al. Characteristics and in-hospital outcomes in young patients presenting with acute coronary syndrome treated by percutaneous coronary intervention. Cardiovasc Interv and Ther 33, 154–162 (2018). https://doi.org/10.1007/s12928-017-0471-z

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  • DOI: https://doi.org/10.1007/s12928-017-0471-z

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