Characterization of Coronary Artery Disease in Young Adults and Assessment of Long-term Outcomes.

BACKGROUND: Contemporary data on clinical profiles and long-term outcomes of young adults with coronary artery disease (CAD) are limited. OBJECTIVES: To determine the risk profile, presentation, and outcomes of young adults undergoing coronary angiography. METHODS: A retrospective analysis (2000-2017) of patients aged ≤ 35 years undergoing angiography for evaluation and/or treatment of CAD was conducted. RESULTS: Coronary angiography was performed in 108 patients (88% males): 67 acute coronary syndrome (ACS) and 41 non-ACS chest pain syndromes. Risk factors were similar: dyslipidemia (69%), positive family history (64%), smoking (61%), obesity (39%), hypertension (32%), and diabetes (22%). Eight of the ACS patients (12%) and 29 of the non-ACS (71%) had normal coronary arteries without subsequent cardiac events. Of the 71 with angiographic evidence of CAD, long-term outcomes (114 ± 60 months) were similar in ACS compared to non-ACS presentations: revascularization 41% vs. 58%, myocardial infarction 32% vs. 33%, and all-cause death 8.5% vs. 8.3%. Familial hypercholesterolemia (FH) was diagnosed in 25% of those with CAD, with higher rates of myocardial infarction (adjusted hazard ratio [HR] 2.62, 95% confidence interval [95%CI] 1.15-5.99) and revascularization (HR 4.30, 95%CI 2.01-9.18) during follow-up. Only 17% of patients with CAD attained a low-density lipoprotein cholesterol treatment goal < 70 mg/dl. CONCLUSIONS: CAD in young adults is associated with marked burden of traditional risk factors and high rates of future adverse cardiac events, regardless of acuity of presentation, especially in patients with FH, emphasizing the importance of detecting cardiovascular risk factors and addressing atherosclerosis at young age.

Comparison of radial versus femoral approach for percutaneous coronary interventions in octogenarians.

BACKGROUND: The safety and efficacy of a radial approach for percutaneous coronary intervention (PCI) in octogenarians is not well established. METHODS: To evaluate the benefits of a radial approach for preventing vascular complications after PCI, clinical, procedural, and outcome data were prospectively collected and compared for 228 octogenarians undergoing elective PCI either through a radial or a femoral approach. RESULTS: Radial approach was associated with longer cannulation (3.1 +/- 2.9 vs. 2.0 +/- 2.0 min, P < 0.001) and fluoroscopy times (19.3 +/- 16.1 vs. 16.1 +/- 11.8 min, P = 0.04), greater utilization of contrast media (224 +/- 46 vs. 182 +/- 20 ml, P < 0.001) and higher crossover rate (11 vs 4%, P = 0.03) to alternate access site compared with the femoral approach. However, ambulation time (5.2 +/- 3.1 vs. 11.6 +/- 6.3 hr, P < 0.001), access site bleeding (4 vs. 14%, P = 0.007), hematoma (1 vs. 11%, P = 0.001) or any vascular complication (5 vs 26%, P = 0.001) were significantly reduced with a radial approach. Procedural success rates were equivalent with both approaches. Multivariate regression analysis identified radial approach (OR = 0.23; CI = 0.08, 0.65) as an independent negative predictor of postprocedural vascular complications. CONCLUSION: Radial approach for PCI in octogenarians is technically challenging for the operator and exposes patients to greater volume of nephrotoxic contrast media. However, it results in early ambulation and significantly reduces vascular complications in this high risk population. These findings support a strategy of preprocedural risk assessment and use of radial approach for PCI in a select group of octogenarians to maximize benefits offered by this technique.