Long-term Outcome And Its Risk Factors Of Drug-eluting Stenting In Age Group 30-39

Background and ObjectiveCoronary heart disease (CHD) is one of the main diseases that threaten people’s health. The incidence rate and death rate of CHD is on the rise. Moreover, the age of onset is decreasing and some of the patients are attacked by the disease when they are young or at middle age. In 2002, the number of patients between age 15 to 59 died of CHD is approximately 1.3 million, rank only second to AIDS, becoming their second leading cause of death. Male patients who are ≤45 and female patients who are ≤ 55 can be considered as early onset CHD patients. Through prospective study, Framingham Heart Study explored all kinds of factors that are related to cardiovascular disease and proposed the concept of risk factors. Through continuous technological advance and instrument improvement, PCI has become the important strategy for the treatment of CHD. Compared with bare-metal stent (BMS), drug-eluting stent (DES) can significantly reduce the in-stent restenosis (ISR) of target vessels, so it is widely used in PCI. Compared with old CHD patients, young CHD patients have different risk factors, clinical characteristics, the coronary artery disease characteristics and outcome. However, at present, we lack the long-term outcome result data of young CHD patients after drug eluting stent implantation. Hereby we study the incidence of MACEs of CHD patients between age 30 to 39 after drug eluting stent implantation, as well as its relationships with traditional risk factors and its incidence rate.MethodsWe selected 87 relatively young CAD patients between age 30 to 39 years old who underwent drug-eluting stenting and 40 subjects who were age-and sex-matched and angiographically shown to be disease free as controls. MACEs were analyzed in CHD patients for a median of 24 months, as well as its relations with traditional risk factors.ResultsMale patients accounted for 94.2% of total cases. Compared with controls, CHD patients in this group had higher body mass index and rates of smoking, family history of CHD, and incident rate of diabetes and hypercholesterolemia. At the end of follow-up,1 patient died, the overall death rate was 1.1%. MACEs were observed in 10 patients (11.5%). On Cox proportional hazard analyses, positive family history(HR1.32,95%CI 1.08-1.61, p=0.012), diabetes(HR2.78,95%CI 2.27-3.09, p <0.001) and smoking(HR1.73,95%CI 1.16-2.66, p<0.001) were independent risk factors of MACEs.ConclusionsOur research results demonstrate that family history of CHD serves as an important predictor of major adverse cardiovascular events in CAD patients in this age group who underwent drug-eluting stenting. The influence of family history is independent of other well-known risk factors. Genetic factors may play an important role in the development of CHD and may be associated with long-term outcomes in relatively young CHD patients in this age group who underwent drug-eluting stenting. We have known that diabetes is a risk factor of both early- and late-onset CHD. In recent years, diabetes was found to be an independent predictor of long-term mortality in early onset CHD with PCI, but we lack studies revealing the relationship between diabetes and prognosis of drug-eluting stenting in early onset CHD. In our study, after a median follow-up of 24 months, diabetes was found a strong risk factor of major cardiovascular events after drug-eluting stenting, which indicates an important risk factor for the long-term outcome of CHD patients in this age group. Several studies have proved that smoking is an important risk factor of CHD patients. Our research finds that smoking plays an important predictor of long-term outcome in patients underwent drug-eluting stenting, and smoking is an important risk factor in long-term outcome of relatively young CHD patients.Significance:Recently, several large scale studies have shown that traditional risk factors (for example, gender, family history, diabetes, dyslipidemia and smoking) are strongly related to early-onset CHD. By showing the obvious higher smoking rate, family history of CHD, diabetes and hypercholesterolemia incidence rate of CHD patients in this age group, our study proves the preceding result, and proposes family history of CHD and diabetes are independent risk factors to influence the long-term outcome of patients in this age group.