ABSTRACT Background: Drug-eluting stents (DESs) are associated with lower restenosis rates. However, minimal data on the follow up results of premature coronary artery disease (PCAD) treated with DESs exist. This study was to evaluate clinical characteristics and one- year prognosis of PCAD implanted with DESs in a Chinese population. Methods: 282 patients with PCAD, of which 177 implanted with DESs and 105 prescribed medicine alone were enrolled and analyzed. Major adverse cardiovascular events (MACEs) and the use of medications for secondary prevention were collected and analyzed. Results: Compared with those receiving medicine alone, patients implanted with DESs had higher ratios of males than females, they also had acute coronary syndromes, multi-vessel disease, higher values of cardiac troponin I, longer hospital stays, higher aspirin and clopidogrel use (all P < 0.05); though these patients had higher use of aspirin and clopidogrel in the hospital and during follow-up and higher β-blockers and statins use during follow-up, they had higher ratios of recurrent angina and composite MACEs during one-year follow- up (all P < 0.05). Logistic regression analyses showed that obesity (OR 1.757, 95% CI: 1.031 - 2.995), acute coronary syndrome (OR 1.716, 95% CI: 1.011 - 2.913) and reduced left ventricular ejection fraction (OR 2.539, 95% CI: 1.180 - 5.463) predict MACEs in a one-year follow-up among patients with PCAD. Conclusions: PCAD patients implanted with DESs have more unstable clinical phenotypes and higher MACEs during a one-year follow-up period, though they were prescribed higher ratios of optimal therapeutic medicine. Further enhanced strategies should be made for secondary prevention.
Cite this paper
Zhang, X. , Tang, Y. , Ma, G. and Chen, Z. (2013) Clinical follow up of patients with premature coronary artery disease (PCAD) implanted with drug-eluting stents. World Journal of Cardiovascular Diseases, 3, 329-335. doi: 10.4236/wjcd.2013.34052.
 Akosah, K.O., Gower, E., Groon, L., Rooney, B.L. and Schaper, A. (2000) Mild hypercholesterolemia and premature heart disease: Do the national criteria underestimate disease risk? Journal of the American College of Cardiology, 35, 1178-1184.
 Gurevitz, O., Jonas, M., Boyko, V., Rabinowitz, B. and Reicher-Reiss, H. (2000) Clinical profile and long-term prognosis of women/or =50 years of age referred for coronary angiography for evaluation of chest pain. American Journal of Cardiology, 85, 806-809.
 Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (2001) Executive summary of the third report of the national cholesterol education program expert panel on detection, evaluation, and treatment of high blood cholesterol in adults (adult treatment panel III). JAMA, 285, 2486-2497.
 Klein, L.W. and Nathan, S. (2003) Coronary artery disease in young adults. Journal of the American College of Cardiology, 41, 529-531.
 Cole, J.H., Miller 3rd, J.I., Sperling, L.S. and Weintraub, W.S. (2003) Long-term follow-up of coronary artery disease presenting in young adults. Journal of the American College of Cardiology, 41, 521-528.
 Cole, J.H. and Sperling, L.S. (2004) Premature coronary artery disease: Clinical risk factors and prognosis. Current Atherosclerosis Reports, 6, 121-125.
 Khunti, K., Stone, M., Paul, S., Baines, J., Gisborne, L., Farooqi, A., Luan, X. and Squire, I. (2007) Disease management programme for secondary prevention of coronary heart disease and heart failure in primary care: A cluster randomised controlled trial. Heart, 93, 1398-1405.
 AHA, ACC, National Heart, Lung and Blood Institute, Smith Jr, S.C., Allen, J., Blair, S.N., Bonow, R.O., Brass, L.M., Fonarow, G.C., Grundy, S.M., Hiratzka, L., Jones, D., Krumholz, H.M., Mosca, L., Pearson, T., Pfeffer, M.A. and Taubert, K.A. (2006) AHA/ACC guidelines for secondary prevention for patients with coronary and other atherosclerotic vascular disease: 2006 update endorsed by the National Heart, Lung and Blood Institute. Journal of the American College of Cardiology, 47, 2130-2139.
 Graham, I., Atar, D., Borch-Johnsen, K., Boysen, G., Burell, G., Cifkova, R., Dallongeville, J., De Backer, G., Ebrahim, S., Gjelsvik, B., Herrmann-Lingen, C., Hoes, A., Humphries, S., Knapton, M., Perk, J., Priori, S.G., Pyorala, K., Reiner, Z., Ruilope, L., Sans-Menendez, S., Op Reimer, W.S., Weissberg, P., Wood, D., Yarnell, J., Zamorano, J.L. and ESC Committee for Practice Guidelines (2007) European guidelines on cardiovascular disease prevention in clinical practice: Executive summary. Atherosclerosis, 194, 1-45.
 Pasternak, R.C., Smith Jr., S.C., Bairey-Merz, C.N., Grundy, S.M., Cleeman, J.I., Lenfant, C., American College of Cardiology, American Heart Association, National Heart, Lung and Blood Institute (2002) ACC/AHA/ NHLBI clinical advisory on the use and safety of statins. Journal of the American College of Cardiology, 40, 567572. doi:10.1016/S0735-1097(02)02030-2
 American College of Cardiology and American Heart Association Task Force on Practice Guidelines (2008) 2007 focused update of the 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. Catheterization and Cardiovascular Interventions, 71, E1E40. doi:10.1002/ccd.21475
 Hjalmarson, A., Goldstein, S., Fagerberg, B., Wedel, H., Waagstein, F., Kjekshus, J., Wikstrand, J., El Allaf, D., Vítovec, J., Aldershvile, J., Halinen, M., Dietz, R., Neuhaus, K.L., Jánosi, A., Thorgeirsson, G., Dunselman, P.H., Gullestad, L., Kuch, J., Herlitz, J., Rickenbacher, P., Ball, S., Gottlieb, S. and Deedwania, P. (2000) Effects of controlled-release metoprolol on total mortality, hospitalizations, and well-being in patients with heart failure: The metoprolol CR/XL randomized intervention trial in congestive heart failure (MERIT-HF). JAMA, 283, 12951302. doi:10.1001/jama.283.10.1295
 Yusuf, S., Sleight, P., Pogue, J., Bosch, J., Davies, R., Dagenais, G. and The Heart Outcomes Prevention Evaluation Study Investigators (2000) Effects of an angiotensin-converting enzyme inhibitor, ramipril, on cardiovascular events in high-risk patients. The New England Journal of Medicine, 342, 145-153.
 Moses, J.W., Leon, M.B., Popma, J.J., Fitzgerald, P.J., Holmes, D.R., O’Shaughnessy, C., Caputo, R.P., Kereiakes, D.J., Williams, D.O., Teirstein, P.S., Jaeger, J.L., Kuntz, R.E. and SIRIUS Investigators (2003) Sirolimuseluting stents versus standard stents in patients with stenosis in a native coronary artery. The New England Journal of Medicine, 349, 1315-1323.
 Stone, G.W., Ellis, S.G., Cox, D.A., Hermiller, J., O’Shaughnessy, C., Mann, J.T., Turco, M., Caputo, R., Bergin, P., Greenberg, J., Popma, J.J., Russell, M.E. and TAXUS-IV Investigators (2004) A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. The New England Journal of Medicine, 350, 221-231.
 Kotseva, K., Wood, D., De Backer, G., De Bacquer, D., Pyorala, K., Keil, U. and EUROASPIRE Study Group (2009) EUROASPIRE III: A survey on the lifestyle, risk factors and use of cardioprotective drug therapies in coronary patients from 22 European countries. European Journal of Cardiovascular Prevention & Rehabilitation, 16, 121-137. doi:10.1097/HJR.0b013e3283294b1d
 Lewis, S.J., Robinson, J.G., Fox, K.M., Grandy, S. and SHIELD Study Group (2010) Underutilisation of cardiovascular medications among at-risk individuals. International Journal of Clinical Practice, 64, 604-610.
 Sharma, K.K., Gupta, R., Agrawal, A., Roy, S., Kasliwal, A., Bana, A., Tongia, R.K. and Deedwania, P.C. (2009) Low use of statins and other coronary secondary prevention therapies in primary and secondary care in India. Vascular Health and Risk Management, 5, 1007-1014.
 Moriel, M., Tzivoni, D., Behar, S., Zahger, D., Hod, H., Hasdai, D., Sandach, A. and Gottlieb, S. (2008) Contemporary treatment and adherence to guidelines in women and men with acute coronary syndromes. International Journal of Cardiology, 131, 97-104.
 Javed, U., Deedwania, P.C., Bhatt, D.L., Cannon, C.P., Dai, D., Hernandez, A.F., Peterson, E.D. and Fonarow, G.C. (2010) Use of intensive lipid-lowering therapy in patients hospitalized with acute coronary syndrome: An analysis of 65,396 hospitalizations from 344 hospitals participating in Get With The Guidelines (GWTG). American Heart Journal, 160, 1130-1136.
 Arnold, S.V., Spertus, J.A., Tang, F., Krumholz, H.M., Borden, W.B., Farmer, S.A., Ting, H.H. and Chan, P.S. (2011) Statin use in outpatients with obstructive coronary artery disease. Circulation, 124, 2405-2410.
 Wang, M.H., Lee, W.L., Wang, K.Y., Hsieh, Y.C., Liu, T.J., Lin, I.H., Lin, W.W., Ting, C.T. and Liang, K.W. (2008) Short-term follow-up results of drug-eluting stenting in premature coronary artery disease patients with multiple atherosclerotic risk factors. Journal of the Chinese Medical Association, 71, 342-346.
 Zhou, B. (2002) Predictive values of body mass index and waist circumference to risk factors of related diseases in Chinese adult population. Chinese Journal of Epidemiology, 23, 5-10.
 Cheitlin, M.D., Armstrong, W.F., Aurigemma, G.P., Beller, G.A., Bierman, F.Z., Davis, J.L., Douglas, P.S., Faxon, D.P., Gillam, L.D., Kimball, T.R., Kussmaul, W.G., Pearlman, A.S., Philbrick, J.T., Rakowski, H., Thys, D.M., Antman, E.M., Smith Jr., S.C., Alpert, J.S., Gregoratos, G., Anderson, J.L., Hiratzka, L.F., Hunt, S.A., Fuster, V., Jacobs, A.K., Gibbons, R.J., Russell, R.O., American College of Cardiology, American Heart Association and American Society of Echocardiography (2003) ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: Summary article: A report of the American College of Cardiology/American Heart Association Task Force on practice guidelines (ACC/AHA/ASE Committee to update the 1997 guidelines for the clinical application of echocardiography). Circulation, 108, 1146-1162.
 Pischke, C.R., Weidner, G., Elliott-Eller, M. and Ornish, D. (2007) Lifestyle changes and clinical profile in coronary heart disease patients with an ejection fraction of ≤40% or >40% in the Multicenter Lifestyle Demonstration Project. European Journal of Heart Failure, 9, 928934. doi:10.1016/j.ejheart.2007.05.009
 Pischke, C.R., Elliott-Eller, M., Li, M., Mendell, N., Ornish, D. and Weidner, G. (2010) Clinical events in coronary heart disease patients with an ejection fraction of 40% or less: 3-year follow-up results. Journal of Cardiovascular Nursing, 25, E8-E15.
 Wang, N., Zhao, D., Liu, J., Liu, J., Yu, C.M., Wang, W., Sun, J., Li, Y. and Du, F. on Behalf of the BRIG Project (2011) Impact of heart failure on in-hospital outcomes of acute coronary syndrome patients in China—Results from the bridging the gap on CHD secondary prevention in China (BRIG) project. International Journal of Cardiology, in Press.
 Meliga, E., De Benedictis, M., Gagnor, A., Belli, R., Scrocca, I., Lombardi, P., Conrotto, F., Aranzulla, T., Varbella, F. and Conte, M.R. (2012) Long-term outcomes of percutaneous coronary interventions with stent implantation in patients ≤40 years old. American Journal of Cardiology, 109, 1717-1721.
 Boden, W.E., O’Rourke, R.A., Teo, K.K., Hartigan, P.M., Maron, D.J., Kostuk, W.J., Knudtson, M., Dada, M., Casperson, P., Harris, C.L., Chaitman, B.R., Shaw, L., Gosselin, G., Nawaz, S., Title, L.M., Gau, G., Blaustein, A.S., Booth, D.C., Bates, E.R., Spertus, J.A., Berman, D.S., Mancini, G.B., Weintraub, W.S. and COURAGE Trial Research Group (2007) Optimal medical therapy with or without PCI for stable coronary disease. The New England Journal of Medicine, 356, 1503-1516.
 Stergiopoulos, K. and Brown, D.L. (2012) Initial coronary stent implantation with medical therapy vs medical therapy alone for stable coronary artery disease: Metaanalysis of randomized controlled trials. Archives of Internal Medicine, 172, 312-319.
 Allen, J.K. and Dennison, C.R. (2010) Randomized trials of nursing interventions for secondary prevention in patients with coronary artery disease and heart failure: Systematic review. Journal of Cardiovascular Nursing, 25, 207-220.
 Soran, O.Z., Feldman, A.M., Pina, I.L., Lamas, G.A., Kelsey, S.F., Selzer, F., Pilotte, J. and Lave, J.R. (2010) Cost of medical services in older patients with heart failure: Those receiving enhanced monitoring using a computer-based telephonic monitoring system compared with those in usual care: The heart failure home care trial. Journal of Cardiac Failure, 16, 859-866.