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J Am Coll Cardiol, 2003; 41:521-528, doi:10.1016/S0735-1097(02)02862-0 © 2003 by the American College of Cardiology Foundation |
* Emory Center for Outcomes Research and Section of Preventive Cardiology, Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia, USA
Manuscript received June 5, 2002; revised manuscript received October 8, 2002, accepted October 17, 2002.
* Reprint requests and correspondence: Dr. Joseph I. Miller III, Division of Cardiology, Emory University School of Medicine, Emory University, 1525 Clifton Road, Suite 207, Atlanta, Georgia 30322, USA.
joseph_miller{at}emoryhealthcare.org
OBJECTIVES: This study evaluated long-term survival and predictors of elevated risk for young adults diagnosed with coronary artery disease (CAD).
BACKGROUND: Coronary artery disease is rarely seen in young adults. Traditional cardiac risk factors have been studied in small series; however, many questions exist.
METHODS: We identified 843 patients under age 40 with CAD diagnosed by coronary angiography from 1975 to 1985. Death, hypertension, gender, family history, prior myocardial infarction (MI), diabetes, heart failure, angina class, number of diseased vessels, ejection fraction (EF), Q-wave infarction, in-hospital death, and initial therapy were studied. Patients were followed for 15 years.
RESULTS: The mean age was 35 for women (n = 94) and 36 for men (n = 729). The average EF was 55%. Fifty-eight percent of the subjects had single-vessel disease, and 10% were diabetic. The strongest predictors of long-term mortality were a prior MI (hazard ratio [HR] 1.32, 95% confidence interval [CI] 1.00 to 1.73), New York Heart Association class II heart failure (HR 1.75, 95% CI 1.03 to 2.97), and active tobacco use (HR 1.59, 95% CI 1.14 to 2.21). Revascularization, rather than medical therapy, was associated with lower mortality (coronary angioplasty: HR 0.51, 95% CI 0.32 to 0.81; coronary artery bypass graft: HR 0.68, 95% CI 0.50 to 0.94). Overall mortality was 30% at 15 years. Patients with diabetes had 15-year mortality of 65%. Those with prior MI had 15-year mortality of 45%, and patients with an EF <30% a mortality of 83% at 15 years.
CONCLUSIONS: Coronary disease in young adults can carry a poor long-term prognosis. A prior MI, diabetes, active tobacco abuse, and lower EF predict a significantly higher mortality.
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