Action Study group DCLARATION DE LIENS D'INTRT AVEC LA PRSENTATION - - PowerPoint PPT Presentation
Michel Zeitouni on behalf of the Action Study group DCLARATION DE LIENS D'INTRT AVEC LA PRSENTATION Speaker's name : Michel ZEITOUNI, Paris Je dclare les liens d'intrt potentiel suivants : Bourse de Recherche : FFC, Institut
Speaker's name : Michel ZEITOUNI, Paris ☑ Je déclare les liens d'intérêt potentiel suivants : Bourse de Recherche : FFC, Institut Servier Honoraires : BMS / pfizer
among young patients
among young women
Arora Sameer et al. Twenty Year Trends and Sex Differences in Young Adults Hospitalized with Acute Myocardial Infarction: The ARIC Community Surveillance Study. Circulation [Internet] [cited 2018 Dec 10]
PROSPECT DAPT PEGASUS PLATO TIMI-TRITON 38 COMPASS - CAD Population ACS/PCI CAD/PCI Post-MI ACS/PCI ACS/PCI High-risk CAD Mean age (years)
58
62 65 62 61 68
Consecutive patients since January 1996 from eight centers Patients 18 – 45 years-old Myocardial infarction or stable angina At least one coronary lesion > 70 % Oral and written consent Prospective follow-up until July 31st, 2017
Inclusion one Month after MI for exhaustive work-up (biobank, imaging) Yearly : data collection by consultation and phone
Appraisal of risk factors in young ischemic patients Justifying aggressive intervention
The primary composite endpoint was ischemic recurrences defined by : all-cause death myocardial infarction Refractory angina requiring PCI or CABG Ischemic stroke
Kaplan Meier analysis survival without events according to lesion site Cox logistic regression with time-dependent co-variates
N= 880 patients between 1996 et 2017 Median follow-up = 9.6 years Complete vital and cardiovascular status except for 5 patients
Baseline characteristics n =880 Age - year (mean) 40∙1 ± 5∙7 Age < 35 % 160 (18∙1) Female gender 117 (13∙3) Myocardial infarction 693 (78∙8) Stable angina 187 (21∙2) Familial history of CAD 359 (40∙8) Active cigarette smoking 680 (77∙3%) Dyslipidaemia 443 (50∙3) LDL-Cholesterol (g/L) 1∙69±1∙30 Arterial hypertension 178 (20∙2) Diabetes 94 (10∙7) Chronic inflammatory disease 87 (9∙9) Angiographic characteristics (n=880) One vessel 529 (60.1) Two vessel 179 (20.3) Three vessel 172 (19.5) Spontaneous coronary artery dissection 10 (1.1) Effort-related thrombosis 11(1.3) Revascularization 803 (91∙2) Drug eluting stent 478 (54.4) Bare metal stent 304 (34.7) Thrombus aspiration only 11 (1.3) Coronary artery bypass graft 57 (6.5) Medical treatment 30 (3.4)
1st recurrence Time 2nd recurrence Recurrences ≥ 3 Total Events (n=264) (year, median) (n=81) (n=54) Primary endpoint 264 (29∙9) 4∙2 399 All-cause Death 39 (4∙4) 8∙4 11 (1∙3) 5 (0∙6) 55 (6∙3) Myocardial Infarction 131 (14∙9) 3∙7 40 (4∙5) 38 (4∙3) 209 (23∙8) STEMI 47 (5∙3) 4∙1 10 (1∙1) 12 (1∙4) 69 (7∙8) NSTEMI 84 (9∙5) 3∙5 30 (3∙4) 26 (3∙0) 140 (15∙9) Refractory Ischemia requiring revascularization 88 (10∙0) 5∙1 28 (3∙2) 11 (1∙3) 127 (14∙4) PCI 66 (7∙5) 6∙3 18 (2∙0) 2 (0∙2) 85 (9∙7) CABG 22(2∙5) 2∙8 10 (1∙1) 9 (1∙0) 41 (4∙7) Ischemic Stroke 6(0∙7) 5∙4 2 (0∙2) 0 (0) 8 (0∙9)
Ischemic recurrences occurred in 1/3 of the patients within a median time of 4 years (4.2 per 100 patient-years)
Ischemic recurrences were mainly related to new lesions 15.4 % vs 7.5 %, p<0.001, HR = 1.45
A STEMI before 45 is always shocking Short-term prognosis is good. Coronaries are back to normal after PCI! Premature CAD is an aggressive chronic affection starting 20 years in advance Disconnect between what we see and long-term evolution Most of the recurrent events occured before comorbidities Smoking is the killer as well as chronic inflammation
AFIJI PROSPECT DAPT STUDY PEGASUS TIMI 54 COMPASS-CAD CAD<45 ACS/PCI CAD/PCI Post-MI High-risk CAD Mean age 40 58 62 65 68 Active smokers 77% 48% 21% 17% 20% Diabetes 11% 17% 31% 32% 37% Multi-vessel disease 39% 79% NA 59% 63% Inflammatory disease 10% NA NA NA NA Events rate per 100 patient-years* 2.2 1.48 1.56 1.79 1.39
Limitations Different follow-up durations, different therapeutic eras Perspectives Ethnic and genetic analysis (DNA-tech) Hypercholesterolemia analysis Socio-professional status (ESC 2018) Vascular age with Cardiac MRI (FARMACOPE study) Collaboration with Duke Clinical Research Center Impact of inflammation and collaboration with CANTOS investigators