Title: Comparison of Clinical profile and outcome between young (≤45yrs) male and female patients with coronary artery disease undergoing percutaneous coronary intervention, a single center study
Authors: Dr Suresh V Patted, Dr Sanjay C Porwal, Dr Prabhu C Halkati, Dr Sameer Ambar, Dr Prasad M R, Dr V.B Metgudmath, Dr Vishwanath Hesarur, Dr Rajiv S Konin
DOI: https://dx.doi.org/10.18535/jmscr/v5i2.117
Abstract
Background -There is scarcity of data regarding CAD and the outcome following PCI in young south Indian population. We sought to analyze the clinical, coronary angiographic features and outcome in young adults(≤45 years of age) with CAD who underwent PCI and also to compare that between young male and female patients .
Methods- Angiographic and clinical data from total 150 patients aged ≤ 45 years of which, 110 male patients who underwent PCI from January 2014 to January 2016 were compared to age-matched 40 female patients in our centre . All patients were treated according to guidelines. 1, 6 and 12 months clinical follow-up were performed in all patients. Coronary angiography was performed only if patients were symptomatic or TMT positive.
Results –CAD risk factors were more prevalent in young male patients, Diabetes mellitus was found in 32.72%, hypertension (34.54%), dyslipidemia (36.36%), smoking (38.18%), tobacco consumption (21.81%) and hyperhomocysteinemia (23.63%) as compared to female group(17.5%,20%,12.5%,0%,5%,12.5% respectively). Family history of CAD was found to be higher in female patients as compared to males (40% vs 6.36%; p =0.000). Single vessel disease was found to be common among female patients(60% vs 40.92%) and Double vessel disease was common among male patients( 44.5% vs 22.5%). The male patients had higher rate of inhospital MACE(4.54% vs 0%; p=0.170 ). Incidence of adverse events in young male patients at one year were not different from those in young females, including MI (1.81% vs 2.5%), cardiac death (1.81% vs 2.5%), TLR (7.27% vs 2.5%),TVR (1.81% vs 0%); all p=NS.
Conclusion - CAD risk factors and Multi vessel disease were more common in young male patients as compared to young female patients. Family history of CAD and single vessel lesions were more common in young female patients compared to young males with CAD . The in-hospital MACE was higher in young male patients and follow-up incidences of major adverse cardiac events were almost similar between the two groups.
Keywords: Percutaneous coronary intervention (PCI), coronary artery disease (CAD), major adverse cardiac events (MACE), myocardial infarction (MI),target lesion revascularization (TLR),target vessal revascularization (TVR).
References
1. 1. Zimmerman FH, cameron A, Fisher LD, Ng g. Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis (coronary Artery Surgery Study registry). J Am coll cardiol 1995;26(3):654-61.
2. Jalowiel DA, Hill JA. Myocardial infarction in the young and in women. cardiovasc clin 1989; 20:197-206
5. American Diabetes Association. Standards of medical care in diabetes—2016.
Diabetes Care. 2016;39(suppl 1):S1-S106
6. Third report on national cholesterol education program (NCEP). Expert Panel on Detection,Evaluation,and Treatment of High Blood cholesterol in Adults (Adult Treatment Panel III),Executive summary.
7. A Positive Family History of Premature Coronary Artery Disease Is Associated With Impaired EndotheliumDependent Coronary Blood Flow Regulation Volker Scha¨chinger, MD; Martina B. Britten, MD; Mathias Elsner, MD; Dirk H. Walter, MD; Inge Scharrer, MD; Andreas M. Zeiher, MD. Circulation. 1999;100:1502-1508.
8. Smith SC Jr, Feldman TE, Hirshfeld JW Jr, Jacobs AK, Kern MJ, King SB, et al. ACC/AHA/SCAI 2005 guideline update for percutaneous coronary intervention: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/SCAI writing Committee to Update 2001 Guideline for Percutaneous Coronary Interven- tion). Circulation. 2006;113(7):e166-286.
9. ACC/AHA Guidelines for Percutaneous Coronary Intervention (Revision of the 1993 PTCA Guidelines)—Executive Sum-mary Circulation. 2001; 103:3019-3041.
10. Cutlip DE, Windecker S, Mehran R, et al. Clinical end points in coronary stent trials–a case for standard definitions. Circulation.2007;115:2344–51.
11. Kasliwal R, Kulshreshtha A, Agrawal S, Bansal M, Trehan N. Prevalence of cardiovascular risk factors in Indian patients undergoing coronary artery bypass surgery. JAPI. 2006;54:371-5.
12. Gupta R. Meta-analysis of prevalence of hypertension in India. Indian heart journal. 1996;49(1):43-8.
13. Jayachandra S, Agnihotram G, Rao RP, Murthy CV. Risk-factor profile for coronary artery disease among young and elderly patients in Andhra Pradesh. Heart India. 2014;2(1):11.
14. Franklin H. Zimmerman , Cameron A, Fisher LD, Grace N. Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis (Coronary Artery Surgery Study Registry). Journal of the American College of Cardiology. 1995;26(3):654-61.
15. Klag MJ, Ford DE, Mead LA, He J, Whelton PK, Liang K-Y, et al. Serum cholesterol in young men and subsequent cardiovascular disease. New England Journal of Medicine. 1993;328(5):313-8
16. Jason h. Cole, Joseph I. Miller, Sperling LS, Weintraub WS. Long-term follow-up of coronary artery disease presenting in young adults. Journal of the American College of Cardiology. 2003;41(4):521-8.
17. V.S. Srinivas, MBBS, Sangeeta Garg, MD, Abdissa Negassa, PhD, Ji Yon Bang, MS, E. Scott Monrad, MD . Persistent Sex Difference in Hospital Outcome following Percutaneous Coronary Intervention: Results from the New York State Repo .Volume 19 - Issue 6 - June, 2007
18. Zayd I. Alhaddad, Rawan A. Hammoudeh, Rinad R. Tabbalat, Yousef Khader, Imad A. Alhaddad, Ayman J. Hammoudeh. One year prognosis of young Middle Eastern patients undergoing percutaneous coronary interventions. Int J Res Med Sci. 2017 Jan;5(1):257-263.