Premature coronary artery disease, risk factors, clinical presentation, angiography and interventions: Hospital based registry

Background & aims: Premature coronary artery disease (CAD) is endemic in India. We performed a study to identify risk factors, clinical presentation, angiographic findings and interventions in premature CAD. Methods: Successive patients who underwent percutaneous intervention (PCI) were enrolled from January 2018 to June 2021. Premature CAD was defined as women 45-59 y and men 40-54 y and very premature as women <45 y and men <40 y. Descriptive statistics are presented. Univariate odds ratio (OR) and 95% confidence intervals (95%CI) were calculated to identify differences in various groups. Results: 4672 patients (women 936, men 3736) were enrolled. Premature CAD was in 1238 (26.5%; women 31.9%; men 25.1%) and very premature in 212 (4.5%; women 6.5%, men 4.0%). In premature and very premature vs non-premature CAD, OR (95%CI) for high cholesterol _x0001_200 mg/dl [women 1.52(1.03 e2.25) and 1.59(0.79e3.20); men 1.73(1.38e2.17) and 1.92(1.22e3.03)], non-HDL cholesterol _x0001_130 mg/dl [women 1.84(1.35e2.52) and 1.32(0.72e2.42); men 1.69(1.43e1.90) and 1.67(1.17e2.34)], LDL cholesterol [men 1.10(0.95e1.25) and 1.04(0.77e1.41)], and tobacco [women 1.40(0.84e2.35) and 2.14(0.95e4.82); men 1.63(1.34e1.98) and 1.27(0.81e1.97)] were higher while hypertension, diabetes and chronic kidney disease were more in non-premature(p < 0.05). Presentation as STEMI was marginally more in women with premature [1.13(0.85e1.51)] and very premature [1.29(0.75e2.22)] CAD and was significantly higher in men [1.35(1.16e1.56) and 1.79(1.29e2.49)]. Location and extent of CAD were not different. Conclusions: In India, a third of CAD patients presenting for coronary intervention have premature disease. Important risk factors are high total and non-HDL cholesterol and tobacco (men) with greater presentation as STEMI. Extent and type of CAD are similar to non-premature CAD indicating severe disease.

Update in management of coronary bifurcation lesions in the drug-eluting stent era.

Despite advances in percutaneous coronary interventions, treatment of coronary lesions remains a challenge for the interventional cardiologists. It has been relatively more successful to manage the bifurcation lesions, which entail higher procedural success rates, lower costs, shorter hospitalization and lower clinical and angiographic restenosis rates in comparison with non-bifurcation lesions. After introduction of drug-eluting stents, there has been substantial reduction in event rate and main vessel restenosis, although the side branch ostial residual stenosis and long-term restenosis continue to pose a problem. This article reviews the various techniques being currently employed with varying degrees of success.