SPC365

Mortality of young patients with severe coronary disease and no identifiable cardiovascular risk factors

Session: CO 09 - Cardiologia Preventiva
Speaker: Pedro Custodio

Congress: CPC 2021
Topic: J. Preventive Cardiology
Theme: 28. Risk Factors and Prevention
Subtheme: 28.2 Risk Factors and Prevention – Cardiovascular Risk Assessment
Session Type: Comunicações Orais
FP Number: ---
Authors: Pedro Custódio; Luís Oliveira; Gonçalo Cunha; Mariana Gonçalves; Afonso Oliveira; Gustavo Mendes; Sérgio Madeira; João Brito; Sílvio Leal; Rui c Teles; Luís Raposo; Henrique m Gabriel; Pedro Gonçalves; Manuel de Sousa Almeida; Miguel Mendes

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Introduction</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Clinically significant coronary artery disease has a strong correlation with traditionally identifiable cardiovascular risk factors (CRF), namely obesity(defined as IMC&gt;30), diabetes mellitus(DM), dyslipidemia, tobacco consumption, hypertension and chronic renal disease. The majority of these comorbidities are thought to&nbsp; &nbsp;accelerate the atherosclerotic pathways through an inflammasome mediated response, that may take decades to become symptomatic. In young patients with severe coronary artery disease without any of the aforementioned comorbidities, other genetically or environmental factors have a potential role. Despite this, the same&nbsp; cardiovascular risk scores are used.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Objective</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Identify the prevalence of young patients with severe coronary artery disease without any CRF. Evaluate the 5 year mortality in these patients and compare it to patients with CRF.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Retrospective single center study of consecutive patients admitted to the CATH LAB younger than 60years, between January 2007 and December 2015, with a SYNTAX SCORE greater that 22 or with angiographically significant disease(&gt;50% stenosis)&nbsp;of the left main or the proximal left anterior descendent coronary artery. Patients that were not treated surgically nor percutaneously were excluded as were those with an hybrid approach. The presence of CRF was assessed and patients were divided based on having or not at least one of those. Binary logistic regression was used to search for differences between populations and Cox multivariate regression&nbsp;performed to sought for statistical differences in the 5 year mortality accounting for syntax score, age and coronary artery bypass grafting.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;A total of 1103 patients were included. Mean age 52.9&plusmn;6.1years; 924 (83.8%) were male. As for the prevalence of CRF: DM 27.6%; HT 60,5%; Dyslpidemia 61%; Tobacco consumption 66,1%; CRD 3,5% and obesity 25,2%.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;47 patients had no identifiable CRF (4,3%). The global 5 year mortality was 5,3%( 5% for patients with CRF VS 10.6% for those without). The two subgroups showed no differences in terms of age, syntax score and previous CABG. There was no statistically significant difference in the 5 year mortality between the two groups (B=.83; p= 0,079), showing a discrete trend toward lower risk in those with CRF. As expected, there was statistically significant differences in mortality according to the syntax score(p=0,003) and age(p=0,05). CABG surgery showed a trend toward lower mortality(p=0,057).</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conclusion</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Out of the younger patients with severe coronary artery disease, 4,3% showed no CRF. No statiscally significant difference in the 5 year mortality was found when comparing this population to the one with CRF. Currently used cardiovascular risk scores are probably inadequate to estimate future CV events in this population, which may deserve a closer follow-up.</span></span></p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;</span></span></p>