Author + information
- Received July 5, 2019
- Revision received July 29, 2019
- Accepted August 1, 2019
- Published online October 7, 2019.
- Jean-Philippe Collet, MD, PhDa,∗,
- Michel Zeitouni, MDa,∗,
- Niki Procopi, MDa,
- Jean-Sébastien Hulot, MD, PhDb,
- Johanne Silvain, MD, PhDa,
- Mathieu Kerneis, MDa,
- Daniel Thomas, MDa,
- Benoit Lattuca, MDa,
- Olivier Barthelemy, MDa,
- Yoan Lavie-Badie, MDc,
- Jean-Baptiste Esteve, MDd,
- Laurent Payot, MDe,
- Delphine Brugier, PhDa,
- Izolina Lopes, BSca,
- Abdourahmane Diallo, PhDf,
- Eric Vicaut, MD, PhDf,
- Gilles Montalescot, MD, PhDa,∗ (, )@ActionCoeur,
- for the ACTION Study Group
- aSorbonne Université, ACTION Study Group, INSERM UMRS 1166, Institut de Cardiologie, Hôpital Pitié-Salpêtrière (AP-HP), Paris, France
- bUniversité Paris-Descartes, Sorbonne Paris Cité, Paris Cardiovascular Research Center (PARCC), INSERM UMRS 970, Hôpital Européen Georges Pompidou, AP-HP, Paris, France
- cCentre Hospitalo-Universitaire Rangueil, Imagerie Cardiovasculaire, Toulouse, France
- dInfirmerie Protestante de Lyon, Cardiologie, Caluire, France
- eCentre Hospitalier, Cardiologie, Saint-Brieuc, France
- fACTION Study Group, Hôpital Lariboisière (AP-HP), Unité de Recherche Clinique, Paris, France
- ↵∗Address for correspondence:
Dr. Gilles Montalescot, ACTION Study Group, Institut de Cardiologie, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, 75013 Paris, France.
Background The long-term evolution of premature coronary artery disease (CAD) is unknown.
Objectives The objective of this study was to describe the evolution of coronary atherosclerosis in young patients and identify the risk factors of poor outcomes.
Methods Participants age ≤45 years with acute or stable obstructive CAD were prospectively enrolled and followed. The primary endpoint was all-cause death, myocardial infarction (MI), refractory angina requiring coronary revascularization, and ischemic stroke.
Results Eight hundred-eighty patients with premature CAD were included. They were age 40.1 ± 5.7 years, mainly men, smokers, with a family history of CAD or hypercholesterolemia. At baseline presentation, 91.2% underwent coronary revascularization, predominantly for acute MI (78.8%). Over a follow-up of 20 years, one-third (n = 264) of patients presented with a total of 399 ischemic events, and 36% had at least a second recurrent event. MI was the most frequent first recurrent event (n = 131 of 264), mostly related to new coronary lesions (17.3% vs. 7.8%; p = 0.01; hazard ratio [HR]:1.45; 95% confidence interval [CI]: 1.09 to 1.93 for new vs. initial culprit lesion). All-cause death (n = 55; 6.3%) occurred at 8.4 years (median time). Ethnic origin (sub-Saharan African vs. Caucasian, adjusted hazard ratio [adjHR]: 1.95; 95% CI: 1.13 to 3.35; p = 0.02), inflammatory disease (adjHR: 1.58; 95% CI: 1.05 to 2.36; p = 0.03), and persistent smoking (adjHR: 2.32; 95% CI: 1.63 to 3.28; p < 0.01) were the strongest correlates of a first recurrent event. When considering all recurrent events, the same factors and Asian ethnicity predicted poor outcome, but persistent smoking had the greatest impact on prognosis.
Conclusions Premature CAD is an aggressive disease despite the currently recommended prevention measures, with high rates of recurrent events and mortality. Ethnicity and concomitant inflammatory disease are associated with poor prognoses, along with insufficient control of risk factors.
↵∗ Drs. Collet and Zeitouni contributed equally to this paper.
This study was led by the ACTION Study Group at the Institute of Cardiology of Pitié-Salpêtrière Hospital. Dr. Collet has received research grants from AstraZeneca, Bayer, Bristol-Myers Squibb, Daiichi-Sankyo, Eli Lilly, Fédération Française de Cardiologie, Lead-Up, Medtronic, MSD, Sanofi, and WebMD. Dr. Zeitouni has received research grants from Institut Servier and Federation Française de Cardiologie. Dr. Hulot has received research grants (to the institution) from Fédération Française de Cardiologie, Institut Servier, and Sanofi; and has received consulting fees from Novartis and Servier. Dr. Silvain has received research grants from Amed, Amgen, Algorythm, AstraZeneca, Bayer, Daiichi-Sankyo, Eli Lilly, Fondation de France, Gilead Science, Iroko Cardio, Sanofi, and St. Jude Medical. Dr. Kerneis has received research grants from Fédération Francaise de Cardiologie and Institut Servier. Dr. Thomas has received sponsorship to attend scientific meetings and speaker or consultancy honoraria from Pfizer, Novartis, and Pierre Fabre Santé. Dr. Lattuca has received research grants from Biotronik, Daiichi-Sankyo, and Fédération Française de Cardiologie; has received consultant fees from Daiichi-Sankyo and Eli Lilly; and has received lecture fees from AstraZeneca and Medtronic. Dr. Vicaut has received personal fees from Eli Lilly; has served as a consultant for Pfizer, Sanofi, LFB, Abbott, Fresenius, Medtronic, and Hexacath; has been a member of Data Safety Monitoring Board for CERC; has received lecture fees from Novartis; and has received grants from Boehringer Ingelheim and Sanofi. Dr. Montalescot has received research grants from Abbott, Amgen, Actelion, AstraZeneca, Bayer, Boehringer Ingelheim, Boston-Scientific, Bristol-Myers Squibb, Beth Israel Deaconess Medical, Brigham Women’s Hospital, Cardiovascular Research Foundation, Daiichi-Sankyo, Idorsia, Lilly, Europa, Elsevier, Fédération Française de Cardiologie, ICAN, Medtronic, Journal of the American College of Cardiology, Lead-Up, Menarini, MSD, Novo-Nordisk, Pfizer, Sanofi, Servier, The Mount Sinai School, TIMI Study Group, and WebMD. All other authors have reported that they have no relationships relevant to the contents of this paper. Erin D. Michos, MD, MHS, served as Guest Associate Editor for this paper.
- Received July 5, 2019.
- Revision received July 29, 2019.
- Accepted August 1, 2019.
- 2019 American College of Cardiology Foundation
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