Little is known regarding temporal trends in characteristics and outcomes of young (≤50 years) patients who develop symptomatic premature coronary artery disease (CAD). The aim of this study was to describe temporal trends in clinical characteristics and outcomes and gender differences in patients with premature CAD undergoing percutaneous coronary intervention (PCI) over 3 decades. A retrospective analysis of 2,922 consecutive patients ≤50 years of age undergoing PCI from 1980 through 2007 was conducted. Baseline characteristics and in-hospital and long-term outcomes were compared by decade. Gender differences and predictors of mortality were analyzed in the most recent cohort. Although most patients were men (80%), there was an increasing proportion of women over time. An increasing prevalence of diabetes mellitus (10% in 1980 to 1989, 16% in 1990 to 1999, 20% in 2000 to 2007, p <0.001), hypertension (29%, 41%, 57%, p <0.001), and hyperlipidemia (39%, 55%, 73%, p <0.001) coincided with increasing body mass index (28.2 ± 4.6, 29.9 ± 5.8, 30.9 ± 6.7 kg/m2, p <0.001). The proportion of smokers decreased (84%, 76%, 74%, p <0.001). In-hospital mortality (1.0%, 0.8%, 0.9%, p = 0.93) and long-term mortality at 5 years (6%, 6%, 7%, p = 0.97) did not change over time. In contemporary PCI practice, women with premature CAD were more likely to have diabetes mellitus (25% vs 19%, p = 0.02), single-vessel disease (56% vs 41%, p <0.001), and a bleeding complication. In conclusion, there is an increasing burden of cardiovascular risk factors, related mostly to obesity, in patients with premature CAD requiring PCI. Long-term morbidity or mortality in these patients has not improved over the previous 3 decades.
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Published online: January 20, 2011
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