Published: 2016-12-19

One year prognosis of young Middle Eastern patients undergoing percutaneous coronary interventions

Zayd I. Alhaddad, Rawan A. Hammoudeh, Rinad R. Tabbalat, Yousef Khader, Imad A. Alhaddad, Ayman J. Hammoudeh


Background: There is scarcity of data about the outcome in young Middle Eastern patients who undergo percutaneous coronary intervention (PCI). We sought to assess clinical and coronary angiographic features and one year outcome of young compared with older patients following PCI.

Methods: Baseline clinical and coronary angiographic features and major cardiovascular events from hospital admission to one year were assessed in young patients (<45 years of age) compared with older patients (>45 years of age).

Results: Of 2426 patients; 308 (12.7%) were young. Young and older patients were predominantly males (76.3% vs. 79.8%; p=0.18) and had similar prevalence of hypertension, diabetes, dyslipidemia, and cigarette smoking. There were no differences between young and older patients in the rates of acute coronary syndrome as an indication for PCI (75.6% vs. 76.1%; p=0.90). The two groups had similar prevalence of one-vessel coronary artery disease (55.2% vs. 58.1%; p=0.37) and intervention for one vessel (74.0% vs. 72.1%; p=0.53). No significant differences were observed in the incidence of in-hospital adverse events in young compared with older patients. Incidence of adverse events in young patients at one year were not different from those in older patients, including cardiac death (3.63% vs. 2.11%), stent thrombosis (3.63% vs. 2.08%), major bleeding (1.30% vs. 1.18%), and coronary revascularization (3.65% vs. 3.24%); all p=NS.

Conclusions: Among Middle Eastern patients undergoing coronary intervention; 13% were 45 years of age or younger. No favourable risk profile, coronary angiographic features or cardiovascular outcome were observed in young compared with older patients.


Cardiovascular disease in the Middle East, Cardiovascular disease in the young, Percutaneous coronary intervention

Full Text:



Gehani AA, Al-Hinai AT, Zubaid M, Almahmeed W, Hasani MR, Yusufali AH, et al. for the INTERHEART Investigators in Middle East. Association of risk factors with acute myocardial infarction in Middle Eastern countries: the INTERHEART Middle East study. Eur J Prev Cardiol. 2014;21:400-10.

Alsheikh-Ali AA, Omar MI, Raal FJ, Rashed W, Hamoui O, Kane A, et al. Cardiovascular risk factor burden in Africa and the Middle East: the Africa Middle East Cardiovascular Epidemiological (ACE) study. PloS One. 2014;9(8):e102830.

Hammoudeh AJ, Al-Tarawneh H, Elharassis A, Haddad J, Mahadeen Z, Badran N, et al. Prevalence of conventional risk factors in Jordanians with coronary heart disease: The Jordan Hyperlipidemia And Related Targets Study (JoHARTS). Int J Cardiol. 2006;110:179-83.

Hammoudeh AJ, Izraiq M, Hamdan H, Tarawneh H, Harassis A, Tabbalat R, et al. High-sensitivity C - reactive protein is an independent predictor of future cardiovascular events in Middle Eastern patients with acute coronary syndrome. CRP and prognosis in acute coronary syndrome. Inter J Atheroscl 2008;3:50-5.

Hosseini SK, Soleimani A, Karimi AA, Sadeghian S, Darabian S, Abbasi SH, et al. Clinical features, management and in-hospital outcome of ST elevation myocardial infarction (STEMI) in young adults under 40 years of age. Monaldi Arch Chest Dis. 2009;72:71-6.

Ahmed E, El-Menyar A, Singh R, Al Binali HA, Al Suwaidi J. Effect of age on clinical presentation and outcome of patients hospitalized with acute coronary syndrome a 20-year registry in a middle eastern country. Open Cardiovasc Med J. 2012;6:60-7.

Avezum A, Makdisse M, Spencer F, Gore JM, Fox KA, Montalescot G, et al. GRACE Investigators. Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). Am Heart J. 2005;149:67-73.

Cutlip DE, Windecker S, Mehran R, Boam A, Cohen DJ, van Es GE, et al. on behalf of the Academic Research Consortium. Clinical end points in coronary stent trials. A Case for standardized definitions. Circulation. 2007;115:2344-51.

Subherwal S, Bach RG, Chen AY, Gage BF, Rao SV, Newby LK, et al. Baseline risk of major bleeding in non-ST-segment elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients Suppress ADverse outcomes with Early implementation of the ACC/AHA guidelines) Bleeding Score. Circulation. 2009;119:1873-82.

Anderson RE, Pfeffer MA, Thune JJ, McMurray JJ, Califf RM, Velazquez E, et al. High-risk myocardial infarction in the young: the VALsartan In Acute myocardial iNfarcTion (VALIANT) trial. Am Heart J. 2008;155:706-11.

Esteban MR, Montero SM, Sanchez JJ, Hernandez HP, Perez JJ, Afonso JH, et al. Acute coronary syndrome in the young: Clinical characteristics, risk factors and prognosis. Open Cardiovasc Med J. 2014;8:61-7.

Desai N, Cortes A, Kita K, Rad N, Shavelle DM, Mehra A, et al. Young patients with acute myocardial infarction: How are thy different? JACC CV Interven. 2013;6:S9.

Chua SK, Hung HF, Shyu KG, Cheng JJ, Chiu CZ, Chang CM, et al. Acute ST-elevation myocardial infarction in young patients: 15 years of experience in a single center. Clinical Cardiology. 2010;33:140-8.

Roversi S, Biondi-Zoccai G, Romagnoli E, Sheiban I, De Servi S, Tamburino C, et al. Early and long-term outlook of percutaneous coronary intervention for bifurcation lesions in young patients. Int J Cardiol. 2013;167:2995-9.

Schoenenberger AW, Radovanovic D, Stauffer JC Windecker S, Urban P, Niedermaier G, et al, for the AMIS Plus Investigators. Acute coronary syndromes in young patients: presentation, treatment and outcome. Int J Cardiol. 2011;148:300-4.

Rallidids LS, Lekakis J, Panagiotakos D, Fountoulaki K, Komporozos C, Apostolou T, et al. Long-term prognostic factors of young patients (<35 years) having acute myocardial infarction: the detrimental role of continuation of smoking. Eur J Cardiovasc Prev Rehabil. 2008;15:567-1.

Dar MA, Mufti AA, Beshir Y, Khalaf H, Soomro TI, Al Shammary O, et al. ST elevation myocardial infarction in young adults: demographics, risk factor profile and early outcome after primary percutaneous coronary intervention. J Saudi Heart Assoc. 2013;25:145.

Johnston SS, Curkendall S, Makenbaeva D, Mozaffari E, Goetzel R, Burton W, et al. The direct and indirect cost burden of acute coronary syndrome. J Occup Environ Med. 2011;53:2-7.

Egred M, Viswanathan G, Davis G. Myocardial infarction in young adults. Postgrad Med J. 2005;81:741-5.

Lindholm D, James S, Odenstedt J, Johnston N, Persson J, Venetsanos D, et al. Different risk factor profile in young versus older patients with acute coronary syndrome: a Swedish coronary angiography and angioplasty registry study. J Am Coll Cardiol. 2015;65:10S.

Arantes C, Martins J, Braga CG, Ramos V, Vieira C, Gaspar A, et al. Acute coronary syndrome in young adults. DOI: 10.1093/ eurheartj/ eht309.P3134.

Chen YL, Bhasin A, Youssef AA, Wu CJ, Yang CH, Hsieh YK, et al. Prognostic factors and outcomes in young Chinese patients with acute myocardial infarction undergoing primary coronary angioplasty. Int Heart J. 2009;50:1-11.

Doughty M, Mehta R, Bruckman D, Das S, Karavite D, Tsai T, et al. Acute myocardial infarction in the young. The University of Michigan experience. Am Heart J. 2002;143:56-62.

Wilmot KA, O’Flaherty M, Capewell S, Ford ES, Vaccarino V. Coronary heart disease mortality declines in the United States from 1979 through 2011: evidence for stagnation in young adults, especially women. Circulation DOI: 10.1161/CIRCULATIONAHA.115.015293

Strait KM, Gross CP, Curtis JP, Lansky AJ, Barreto-Filho JA, Lampropulos JF, et al. The VIRGO classification system: taxonomy for young women with acute myocardial infarction. Circulation. 2015. doi:10.1161/ CIRCULATIONAHA.115.016502

D’Onofrio G, Safdar B, Lichtman JH, Strait KM, Dreyer RP, Geda M, et al. Sex differences in reperfusion in young patients with ST-segment–elevation myocardial infarction: results from the VIRGO study. Circulation. 2015;131:1324-32.

Bajaj S, Shamoon F, Gupta N, Rupen P, Neil P, DeBari VA, et al. Acute ST-segment elevation myocardial infarction in young adults: who is at risk? Coronary Artery Disease. 2011;22:238-44.

Tungsubutra W, Tresukosol D, Buddhari W, Boonsom W, Sanguanwang S, Srichaiveth B. Acute coronary syndrome in young adults: The Thai ACS Registry. J Med Assoc Thai. 2007;90 (Suppl 1):81-90.

Jyotsna M, Narayana JVS. Obstructive coronary artery disease in young females. JACC CV intervene. 2013;6:S24.

Hammoudeh A, Alhaddad I. Triggers and the Onset of Acute Myocardial Infarction. Cardiology in Review. 2009;17:270-4.

Saleh A, Hammoudeh AJ, Hamam I, Khader YS, Alhaddad I, Nammas A, et al. Prevalence and impact on prognosis of glucometabolic states in acute coronary syndrome in a Middle Eastern country: The GLucometabolic abnOrmalities in patients with acute coronaRY syndrome in Jordan (GLORY) study. Inter J Diab Develop Countries. 2012;32:37-43.

Zimmerman FH, Cameron A, Fisher LD, Ng G. Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis (Coronary Artery Surgery Study Registry). J Am Coll Cardiol. 1995;26:654-61.

Ajlouni K, Khader YS, Batieha A, Ajlouni H, El-Khateeb M. An increase in prevalence of diabetes mellitus in Jordan over 10 years. J Diab Complic. 2008;22:317-24.

Geiss LS, Wang J, Cheng YJ, Thompson TJ, Barker L, Li Y, et al. Prevalence and incidence trends for diagnosed diabetes among adults aged 20 to 79 years, United States, 1980-2012. JAMA. 2014;312:1218-26.

Mente A, Yusuf S, Islam S, McQueen MJ, Tanomsup S, Onen CL, et al, INTERHEART Investigators. Metabolic syndrome and risk of acute myocardial infarction a case-control study of 26,903 subjects from 52 countries. J Am Coll Cardiol. 2010;55:2390-8.

Fournier JA, Sanchez A, Quero J, Fernandez-Cortacero JA, Gonzalez-Barrero A. Myocardial infarction in men aged 40 years or less: a prospective clinical-angiographic study. Clin Cardiol. 1996;19:163-6.

Shah AJ, Veledar E, Hong Y, Bremner JD, Vaccarino V. Depression and history of attempted suicide as risk factors for heart disease mortality in young individuals. Arch Gen Psychiatry. 2011;68:1135-42.

Egred M, Viswanathan G, Davis GK. Myocardial infarction in young adults. Postgrad Med J. 2005;81:741-5.

Carrillo X, Curos A, Muga R, Serra J, Sanvisens A, Bayes-Genis A. Acute coronary syndrome and cocaine use: 8-year prevalence and in hospital outcomes. Eur Heart J. 2011;32:1244-50.