Distribucija rizičnih čimbenika i dugoročni ishodi u mladih bolesnika podvrgnutih perkutanoj koronarnoj intervenciji u Makedoniji

Abstract

The aim was to assess coronary artery disease (CAD) risk factor distribution and long-term outcomes in young patients undergoing percutaneous coronary intervention (PCI) in Macedonia. A total of 12,361 PCI patients (from March 2011 to December 2017) were included in the study. Group 1 included 309 young patients aged ≤40 as the main study group, comparing them to 12,052 older PCI patients (group 2) during the study period. We compared CAD risk factor distribution, clinical and procedure characteristics. Additionally, angiographic data, long-term major adverse cardiac and cerebrovascular events (MACCE) and mortality were analyzed in group 1 patients. Median age was 36±4 years in group 1 and 62±11 years in group 2. Male patients predominated in both groups (88% vs.73%). Positive family history for CAD, smoking and obesity was much more common in the young group (p<0.0001). ST segment elevation myocardial infarction (STEMI) primary PCI was also more frequent with 48% of PCI in the young group (p<0.0001). Multivessel CAD and chronic total occlusion interventions were more common in the older group (51% and 28%, respectively; p<0.0001). Procedure duration (31±0.4 vs. 35±22 min) and fluoroscopy time (9±4 vs. 9±12 min) were similar in both groups. There was no difference in access site bleeding (4.8% vs. 4.3%). During the 3.5-year median follow up, MACCE was present in 1.9% of young patients. In conclusion, positive family history for CAD, obesity and smoking were the most common risk factors in the young PCI population. Young PCI patients usually had single vessel CAD with STEMI being more frequent as the cause for primary PCI. Long-term annual survival exceeded 99% in these patients with excellent prognosis after PCI.Cilj istraživanja bio je procijeniti distribuciju rizičnih čimbenika za koronarnu arterijsku bolest (KAB) i dugoročne ishode kod mladih bolesnika podvrgnutih perkutanoj koronarnoj intervenciji (PKI) u Makedoniji. U istraživanje je bilo uključeno ukupno 12.361 bolesnika podvrgnutih PKI (od ožujka 2011. do prosinca 2017. godine). Skupina 1. obuhvatila je 309 mladih bolesnika u dobi od ≤40 godina kao glavna ispitna skupina koja je tijekom istraživanja uspoređena sa skupinom 2. koja je uključivala 12.052 starijih bolesnika. Uspoređivali smo distribuciju rizičnih čimbenika za KAB te kliničke osobine i značajke zahvata. Uz to, u skupini 1. analizirani su angiografski podaci, dugoročni teži štetni srčani i cerebrovaskularni događaji (major adverse cardiac and cerebrovascular events, MACCE) i smrtnost. Medijan dobi bio je 36±4 godine u skupini 1. i 62±11 godine u skupini 2. Pozitivna obiteljska anamneza za KAB, pušenje i pretilost bili su znatno češći u mladoj skupini (p<0,0001). Primarna PKI zbog STEMI bila je također češća s 48% PKI u mladoj skupini (p<0,0001). KAB višestrukih krvnih žila i intervencije zbog kronične potpune okluzije bile su češće u starijoj skupini (51% odnosno 28%; p<0,0001). Trajanje zahvata (31±0,4 prema 35±22 min) i fluoroskopije (9±4 prema 9±12 min) bilo je slično u objema skupinama. Nije bilo razlike u krvarenju na ulaznom mjestu (4,8% prema 4,3%). Tijekom medijana praćenja od 3,5 godine MACCE su zabilježeni u 1,9% mladih bolesnika. U zaključku, najčešći čimbenik rizika u populaciji mladih bolesnika podvrgnutih PKI bila je pozitivna obiteljska anamneza za KAB, pretilost i pušenje. Mladi bolesnici uglavnom su imali KAB jedne krvne žile i podvrgnuti su primarnoj PKI zbog STEMI. Dugoročno godišnje preživljenje bilo je više od 99% u ovih bolesnika s izvrsnom prognozom nakon PKI