Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients

Abstract

Background: Coronary artery disease is most common in older patients, but may occur in younger subjects. The outlook of young patients after percutaneous coronary intervention (PCI) of challenging lesion subsets such as coronary bifurcations, is not established. We thus aimed to appraise the early and long-term results of PCI for bifurcations in young patients. Methods: A multicenter, retrospective study was conducted enrolling consecutive patients undergoing bifurcation PCI between 2002 and 2006 in 22 Italian centers. Patients were divided in 2 groups: age ≤45 years, and age >45 years. The primary end-point was long-term rate of major adverse cardiac events (MACE). Results: 4,314 patients were included: 195 (4.5%) in the younger group, and 4119 (95.5%) in the older group. 30-day outcomes did not show significant differences in MACE rates, with 1.0% in the ≤45 years group and 2.1% in the >45 years group (p=0.439), with death in 0.5% and 1.2% (p=0.388). At long-term follow-up (24.4± 15.1 months), younger patients showed similar rates of MACE, (12.8% vs. 16.6%, p=0.161), myocardial infarction (3.1% vs. 3.7%, p=0.633), target lesion revascularization (11.3% vs. 12.5%, p =0.627), or stent International Journal of Cardiology xxx (2012) xxx-xxx ☆ All authors take responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.

One year prognosis of young Middle Eastern patients undergoing percutaneous coronary interventions

“…One year death rate in young patients in our study (3.6%) was not very different from those reported by other studies, and ranged between 1% and 4.8%. 14,35,39 In concordance with other investigators; we did not find a favorable outcome (death, revascularization, ST or major bleeding) in young compared with older patients.…”

“…Although 45 years of age or younger is the age used more often than others; studies defined age as <35 years, <40 years, <44, <46 years, <50, and <55 years. [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] Young patients, in general, account for <12% of CAD or ACS patients. 21,27 Studies reported percentages as low as 2.6% and 5.8%, and as high as 8% and 11.6%; less than the 13% reported in this study.…”

“…12,27,29 The study that reported data of more than 2000 of young patients was a 7-year nationwide registry. 14 There are an increasing number of young patients admitted with ACS or who undergo PCI. This is most likely due to the increasing prevalence of cardiovascular risk factors in younger age groups, including DM, dyslipidemia, cigarette smoking, metabolic syndrome, obesity, and illicit drug use.…”

A true bifurcational stenosis treated with a bioresorbable vascular scaffold and a drug‐eluting metallic stent: Degradable meets durable

“…True bifurcational lesions are one of the major challenges in interventional cardiology. Of the various techniques for treating such lesions, a single‐stent approach is preferred, since the complication and in‐stent restenosis rates are lower than when two stents are used . Lesions exist, however, that require a two‐stent technique , especially when a long lesion affects the side branch as in this particular case.…”

“…Of the various techniques for treating such lesions, a single‐stent approach is preferred, since the complication and in‐stent restenosis rates are lower than when two stents are used . Lesions exist, however, that require a two‐stent technique , especially when a long lesion affects the side branch as in this particular case. Although it has been described from bench testing that crossing a BRS with another BRS into the side‐branch ostium is possible , a drug‐eluting metallic stent was chosen due to the increased risk of a neo‐carina, which can possibly emerge when using the TAP technique and consequently two 150‐µm layers of BRS.…”