Background
Methods
Subjects
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Inclusion criteria were: hospitalized in cardiac center during an established period; underwent coronary angiography; in accordance with the 1979 World Health Organization (WHO) standard, stenosis of left main artery ≥30%, or one or more of the left anterior descending branch (LAD), left circumflex branch (LCx), or right coronary artery (RCA) ≥50%; diagnosed with CHD.
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Exclusion criteria were: severe cardiomyopathy; rheumatic heart disease; congenital heart disease; severe congenital heart disease; malignant tumor; use of oral contraceptive pill or currently pregnant.
Clinical data collection
Follow-up
Definition
Statistical analysis
Results
Trends of clinical baseline data in young CHD patients
Variable | 2010 (n = 804) | 2011 (n = 930) | 2012 (n = 1045) | 2013 (n = 1241) | 2014 (n = 1268) |
P
|
---|---|---|---|---|---|---|
Age | 40.4 ± 4.2 | 40.6 ± 4.1 | 40.7 ± 4.2 | 40.8 ± 4.2 | 40.8 ± 4.2 | NS |
Male (%) | 766 (91.2) | 876 (94.2) | 983 (94.1) | 1146 (92.3) | 1184 (93.4) | NS |
SBP (mmHg) | 123.9 ± 16.9 | 124.8 ± 16.9 | 123.9 ± 14.9 | 123.7 ± 15.3 | 123.5 ± 15.5 | NS |
DBP (mmHg) | 78.2 ± 12.4 | 77.9 ± 12.1 | 77.0 ± 11.2 | 77.9 ± 11.4 | 77.6 ± 11.9 | NS |
HR | 72.8 ± 11.8 | 72.4 ± 11.7 | 72.1 ± 11.2 | 74.3 ± 12.7 | 72.0 ± 11.0 | 0.000 |
BMI | 27.9 ± 3.1 | 27.9 ± 3.2 | 27.7 ± 3.2 | 28.1 ± 3.1 | 27.6 ± 3.4 | 0.002 |
Risk factor | ||||||
Hypertension (%) | 342 (40.7) | 379 (40.7) | 496 (47.5) | 498 (40.1) | 529 (41.7) | 0.005 |
Diabetes (%) | 171 (20.3) | 182 (19.6) | 238 (22.7) | 324 (26.1) | 284 (22.4) | 0.006 |
Hyperlipidemia (%) | 230 (27.3) | 244 (26.2) | 371 (35.5) | 362 (29.1) | 453 (35.7) | 0.000 |
Smoke (%) | 502 (59.7) | 572 (61.5) | 646 (61.8) | 710 (57.2) | 728 (57.4) | 0.020 |
Alcohol use (%) | 210 (25.0) | 255 (27.4) | 325 (31.1) | 323 (26.0) | 317 (25.0) | 0.014 |
Geographical differences | ||||||
City area (%) | 543 (67.5) | 605 (65.1) | 651 (65.2) | 857 (69.1) | 843 (66.5) | NS |
Scholarship | 0.000 | |||||
High (%) | 436 (51.9) | 466 (50.1) | 594 (56.8) | 735 (59.2) | 744 (58.7) | |
Middle (%) | 269 (32.0) | 369 (39.7) | 331 (31.7) | 376 (30.3) | 384 (30.3) | |
Low (%) | 99 (11.8) | 95 (10.2) | 120 (11.5) | 130 (10.5) | 140 (11.0) | |
Diagnosis | 0.000 | |||||
SA | 24 (2.8) | 21 (2.2) | 18 (1.7) | 27 (2.1) | 13 (1.0) | 0.024 |
UA | 394 (46.9) | 505 (54.3) | 566 (54.1) | 706 (56.8) | 723 (57.0) | 0.003 |
NSTEMI | 325 (38.7) | 350 (37.6) | 340 (32.5) | 389 (31.3) | 364 (28.7) | 0.000 |
STEMI | 52 (6.2) | 41 (4.4) | 104 (9.9) | 99 (7.9) | 151 (11.9) | 0.000 |
ICM | 9 (1.1) | 13 (1.4) | 17 (1.6) | 20 (1.6) | 17 (1.3) | NS |
Proportion of young CAD the total hospitalized patients (%) | 5.4 | 5.8 | 5.7 | 6.9 | 7.2 | 0.000 |
Proportion of young CAD in the total Cardiac clinic (%) | 2147 (1.2) | 2085 (1.1) | 2283 (1.2) | 3279 (1.5) | 3732 (1.7) | 0.000 |
Laboratory analysis and echocardiography
Variable | 2010 (n = 804) | 2011 (n = 930) | 2012 (n = 1045) | 2013 (n = 1241) | 2014 (n = 1268) |
P
|
---|---|---|---|---|---|---|
Biochemical | ||||||
TC (mmol/L) | 4.54 ± 1.26 | 4.48 ± 1.16 | 4.44 ± 1.35 | 4.42 ± 1.19 | 4.35 ± 1.26 | 0.020 |
TG (mmol/L) | 3.12 ± 6.26 | 2.23 ± 1.51 | 2.28 ± 1.88 | 2.31 ± 1.89 | 2.49 ± 6.83 | 0.026 |
LDL (mmol/L) | 3.21 ± 8.39 | 2.26 ± 0.96 | 2.75 ± 1.09 | 2.74 ± 1.01 | 2.77 ± 3.26 | NS |
HDL (mmol/L) | 0.99 ± 0.22 | 0.94 ± 0.23 | 0.91 ± 0.21 | 0.89 ± 0.21 | 0.89 ± 0.20 | 0.000 |
Creatinine (mg/dL) | 82.59 ± 34.06 | 78.41 ± 16.91 | 78.83 ± 47.32 | 77.85 ± 45.99 | 77.79 ± 18.38 | 0.030 |
BUN (mmol/L) | 7.61 ± 4.85 | 7.29 ± 4.55 | 7.66 ± 5.17 | 7.51 ± 4.54 | 7.18 ± 4.53 | NS |
UA (μmol/L) | 372.1 ± 111.2 | 355.5 ± 88.9 | 359.9 ± 91.3 | 367.9 ± 93.4 | 380.4 ± 91.9 | 0.000 |
ALT (U/L) | 50.2 ± 48.3 | 45.4 ± 35.2 | 48.6 ± 43.1 | 46.8 ± 41.4 | 48.1 ± 42.0 | NS |
AST (U/L) | 62.3 ± 92.7 | 56.7 ± 89.5 | 52.2 ± 77.2 | 51.2 ± 74.3 | 53.1 ± 77.4 | NS |
CK (U/L) | 386.9 ± 875.3 | 368.3 ± 894.6 | 314.4 ± 737.5 | 336.8 ± 718.7 | 377.7 ± 928.1 | NS |
CKMB (ng/ml) | 33.7 ± 76.1 | 29.4 ± 82.1 | 20.8 ± 60.5 | 26.0 ± 138.1 | 29.5 ± 141.3 | NS |
cTnT (ng/ml) | 1.94 ± 1.43 | 1.82 ± 1.31 | 1.87 ± 1.53 | 1.97 ± 2.23 | 1.95 ± 1.97 | NS |
NT-proBNP (pg/ml) | 657.0 ± 3973.8 | 385.6 ± 1348.7 | 372.8 ± 1638.5 | 206.8 ± 572.4 | 197.0 ± 561.7 | 0.000 |
Glucose (mmol/L) | 6.73 ± 2.89 | 6.45 ± 2.51 | 6.57 ± 2.71 | 6.67 ± 2.68 | 6.56 ± 2.88 | NS |
HbA1c (%) | 6.86 ± 1.76 | 6.64 ± 1.72 | 6.71 ± 1.71 | 6.16 ± 1.70 | 6.36 ± 1.63 | NS |
CRP (mg/dl) | 5.22 ± 1.13 | 4.28 ± 1.28 | 4.43 ± 1.56 | 3.54 ± 1.25 | 3.38 ± 0.98 | 0.000 |
Hematologic | ||||||
Hemoglobin (g/L) | 147.4 ± 16.2 | 147.5 ± 15.3 | 146.2 ± 15.6 | 146.8 ± 16.0 | 147.6 ± 15.0 | NS |
Red cell count (10*12/L) | 5.90 ± 1.89 | 5.91 ± 1.92 | 6.00 ± 1.91 | 6.15 ± 1.94 | 6.09 ± 1.99 | 0.017 |
White cell count (10*9/L) | 9.20 ± 3.69 | 8.57 ± 2.99 | 8.41 ± 3.08 | 8.59 ± 3.34 | 8.74 ± 3.36 | 0.005 |
Platelet count | 230.9 ± 72.7 | 228.8 ± 5.96 | 225.6 ± 58.8 | 233.8 ± 58.2 | 236.1 ± 64.2 | NS |
RDW (%) | 12.96 ± 0.69 | 13.03 ± 0.62 | 12.80 ± 0.71 | 12.71 ± 0.79 | 12.91 ± 1.28 | 0.018 |
Echocardiography | ||||||
LVDd (mm) | 50.28 ± 5.38 | 49.64 ± 5.27 | 49.87 ± 5.84 | 49.92 ± 5.71 | 49.42 ± 5.44 | 0.028 |
IVST (mm) | 10.07 ± 1.53 | 10.21 ± 1.51 | 10.13 ± 1.59 | 10.32 ± 1.58 | 10.05 ± 1.60 | 0.002 |
EF (%) | 59.3 ± 9.2 | 59.8 ± 8.9 | 59.8 ± 9.5 | 59.8 ± 9.1 | 59.8 ± 9.0 | NS |
Analysis of coronary artery lesion
Variable | 2010 (n = 804) | 2011 (n = 930) | 2012 (n = 1045) | 2013 (n = 1241) | 2014 (n = 1268) |
P
|
---|---|---|---|---|---|---|
Involved vessel number (%) | ||||||
1 Branch | ||||||
LAD (%) | 256 (31.8) | 320 (34.4) | 368 (35.2) | 408 (32.9) | 384 (30.3) | NS |
LCx (%) | 54 (6.7) | 56 (6.0) | 59 (5.6) | 70 (5.6) | 85 (6.7) | NS |
RCA (%) | 85 (10.5) | 100 (10.7) | 115 (11.0) | 143 (11.5) | 134 (10.6) | NS |
2 branch (%) | 235 (29.2) | 292 (31.4) | 288 (27.6) | 365 (29.4) | 387 (30.5) | NS |
3 branch (%) | 160 (19.9) | 157 (16.9) | 211 (20.2) | 241 (19.4) | 268 (21.1) | NS |
LM (%) | 14 (1.7) | 5 (0.5) | 4 (0.38) | 14 (1.1) | 10 (0.8) | 0.018 |
ACC / AHA classification | ||||||
A (%) | 455 (56.6) | 542 (58.3) | 597 (57.1) | 672 (54.1) | 654 (51.6) | 0.011 |
B1 (%) | 95 (11.8) | 103 (11.1) | 129 (12.3) | 149 (12.2) | 133 (10.5) | NS |
B2 (%) | 112 (13.9) | 144 (15.5) | 148 (14.2) | 202 (16.3) | 225 (17.7) | NS |
C (%) | 142 (17.7) | 141 (15.1) | 171 (16.4) | 218 (17.6) | 256 (20.2) | 0.029 |
TIMI flow (%) | ||||||
TIMI 0 | 218 (27.1) | 223 (24.0) | 266 (25.5) | 347 (28.0) | 368 (29.0) | NS |
TIMI 1 | 2 (0.2) | 12 (1.3) | 3 (0.3) | 4 (0.3) | 6 (0.5) | 0.007 |
TIMI 2 | 16 (2.0) | 13 (1.4) | 6 (0.6) | 22 (1.8) | 14 (1.1) | NS |
TIMI 3 | 568 (70.6) | 682 (73.3) | 770 (73.7) | 868 (69.9) | 880 (69.4) | NS |
Medical treatment
Events in hospital and follow-up
2010 | 2011 | 2012 | 2013 | 2014 |
P
| |
---|---|---|---|---|---|---|
In-hospital outcome | (n = 804) | (n = 930) | (n = 1045) | (n = 1241) | (n = 1268) | |
Death (%) | 15 (1.8) | 10 (1.1) | 3 (0.3) | 2 (0.2) | 7 (0.6) | 0.000 |
Complications (%) | ||||||
Cardiogenic shock | 17 (2.1) | 19 (2.0) | 4 (0.4) | 8 (0.6) | 5 (0.4) | 0.000 |
Major bleeding | 8 (1.0) | 7 (0.8) | 12 (1.1) | 10 (0.8) | 12 (0.9) | NS |
AV block | 2 (0.2) | 1 (0.1) | 2 (0.2) | 3 (0.2) | - | NS |
VT and/or VF | 22 (2.7) | 25 (2.7) | 22 (21.1) | 21 (16.9) | 23 (18.1) | NS |
Thrombosis | 2 (0.2) | 4 (0.4) | 3 (0.3) | 7 (0.6) | 7 (0.6) | NS |
Out-hospital outcome |
N = 738 |
N = 840 |
N = 1017 |
N = 1216 |
N = 1257 | |
MACE (%) | 18 (2.4) | 18 (2.1) | 22 (2.2) | 17 (1.4) | 20 (1.6) | NS |
Cardiac death | 1 (0.1) | - | 1 (0.1) | 3 (0.2) | 1 (0.1) | NS |
MI | 10 (1.3) | 14 (1.7) | 14 (1.4) | 13 (1.1) | 16 (1.3) | NS |
Re-PCI | 17 (2.3) | 18 (2.1) | 22 (2.2) | 17 (1.4) | 19 (1.5) | NS |
CABG | 1 (0.1) | - | - | - | 1 (0.1) | NS |
Stroke | - | - | - | 1 | - | NS |