Comparison Of Clinical Outcomes After Successful Angioplasty And Percutaneous Coronary Intervention With Age Related Differences

Abstract

Background: The clinical manifestations and outcomes of percutaneous coronary intervention (PCI) vary across age, but these differences have not been well delineated, especially in South Asian patients where premature coronary artery disease is becoming common. The majority of the available PCI registry evidence currently is mostly older adult cohorts with a gap in comparative evidence of younger and older patient groups.

Objective: Young (<40 years) and Older (≥40 years) patients presenting with acute coronary syndrome (ACS) undergoing PCI To compare clinical, hemodynamic, comorbidity, lipid and biochemical parameters in each time frame between the presentation of the cases.

Methods: A cross-sectional, and descriptive quantitative study was carried out across several tertiary cardiac centers (EverCare Hospital, Sheikh Zaid, and MSK). Non-probability consecutive sampling was used to recruit a total of 319 patients with established ACS (STEMI, NSTEMI, or unstable angina) undergoing PCI. The patients have been stratified into two categories; Young (<40 years, n = 65) and Older (≥40 years, n = 254). The normality assessment was done by Shapiro-Wilk test and the independent samples t-test or the Mann-Whitney U test was used to compare continuous variables. The chi-square test was used to compare categorical variables. The statistical significance was predetermined at p < 0.05.

Results: Of the 319 patients, 65 (20.4%) were in the Young group and 254 (79.6%) were in the Older group. The ACS type that appeared most frequently in both groups was NSTEMI (Young: 46.2; Older: 42.9), but there was no significant difference in the distribution of ACS types (2 = 0.375, p = 0.829). There was no statistically significant difference between the two groups in gender, BMI, heart rate, blood pressure, total cholesterol, LDL, triglycerides, ALT or any cardiovascular comorbidity such as hypertension (52.3% vs 53.5%), diabetes mellitus (35.4% vs 43.3%) and dyslipidemia (4 NT-proBNP was the most significant parameter with the Older group showing a higher median of 190.9 pg/mL than that of the Young group (146.8 pg/mL) (p = 0.019), showing more myocardial wall stress in the old patients.

Conclusion: At the time of admission, Young and Older ACS patients who came to find PCI had a rather similar clinical profile. Due to high prevalence of the conventional cardiovascular risk factors in the Young group, there is a great burden of premature cardiometabolic risk among South Asian young adults. The only distinguishing biomarker was NT-proBNP, which indicated increased ventricular wall stress among the older group. Future studies that involve the use of angiographic outcomes and post-procedural outcomes data are necessary to complete the characterization of the variations of age on the outcomes of PCI.