title: Prognosis and disease progression in patients under 50 years old undergoing PCI: the CRAGS (Coronary aRtery diseAse in younG adultS) study.
abstract: OBJECTIVE
  Young patients undergoing percutaneous coronary intervention (PCI) are generally considered at low procedural risk, but the potentially aggressive nature of coronary artery disease and long expectancy of life expose them to a high risk of recurrent coronary events. The extent and determinants of disease progression in this patient subset remain largely unknown. The aim of the present study was to evaluate general risk factors for late outcomes among patients ≤50 years old who underwent PCI.
  
  
  METHODS
  Coronary aRtery diseAse in younG adults (CRAGS) is a multicenter European retrospective registry that enrolled 1617 patients (age ≤50 years) who underwent PCI over the years 2002-2012. The median follow-up was 3.0 years.
  
  
  RESULTS
  The majority of patients were smokers who were nevertheless prescribed adequate secondary prevention medication, including statins, aspirin, beta blockers and/or ACE inhibitors/AT blockers. At 5 years, survival was 97.8%, while freedom from major adverse cardiac and cerebrovascular events was 74.1%, from repeat revascularization 77.8% and from myocardial infarction 89.9%. Altogether 13.5% of patients exhibited disease progression that indicated a need for repeat revascularization. Other indications for repeat revascularization were restenosis (7.1%) and stent thrombosis (2.1%) at the 5-year follow-up. Independent post-PCI predictors of disease progression were multivessel disease, diabetes and hypertension.
  
  
  CONCLUSIONS
  PCI is associated with excellent survival in patients ≤50 years old. Nevertheless, despite guideline-adherent medication, every eighth patient underwent repeat revascularization due to disease progression diagnosed at the median follow-up of three years, underscoring the need for more effective secondary prevention than currently available.
authors: Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
authors: Anna
authors: A
authors: Lautamäki
authors: Heart Center, Turku University Hospital and University of Turku, Turku, Finland. Electronic address: juhani.airaksinen@tyks.fi.
authors: K E Juhani
authors: KE
authors: Airaksinen
authors: Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
authors: Tuomas
authors: T
authors: Kiviniemi
authors: Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
authors: Giulia
authors: G
authors: Vinco
authors: Division of Cardiology, Department of Medicine, University of Verona, Verona, Italy.
authors: Flavio
authors: F
authors: Ribichini
authors: Heart Center, Turku University Hospital and University of Turku, Turku, Finland.
authors: Jarmo
authors: J
authors: Gunn
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Vesa
authors: V
authors: Anttila
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Jouni
authors: J
authors: Heikkinen
authors: Department of Internal Medicine, Vaasa Central Hospital, Vaasa, Finland.
authors: Kari
authors: K
authors: Korpilahti
authors: Heart Center, Satakunta Central Hospital, Pori, Finland.
authors: Pasi
authors: P
authors: Karjalainen
authors: Heart Center, Tampere University Hospital, Tampere, Finland.
authors: Olli
authors: O
authors: Kajander
authors: Heart Center, Tampere University Hospital, Tampere, Finland.
authors: Markku
authors: M
authors: Eskola
authors: Heart Center, Tampere University Hospital, Tampere, Finland.
authors: Erkki
authors: E
authors: Ilveskoski
authors: Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors: Tomas
authors: T
authors: Axelsson
authors: Department of Cardiothoracic Surgery, Landspitali University Hospital, Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
authors: Tomas
authors: T
authors: Gudbjartsson
authors: Department of Cardiothoracic Surgery, Sahlgrenska University Hospital, Göteborg, Sweden.
authors: Anders
authors: A
authors: Jeppsson
authors: Department of Surgery, Oulu University Hospital, Oulu, Finland.
authors: Fausto
authors: F
authors: Biancari
mesh_terms: D000328:Adult; D000787:Angina Pectoris / Q000601:surgery*; D003324:Coronary Artery Disease / Q000517:prevention & control; D018450:Disease Progression; D006801:Humans; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D011379:Prognosis; D012042:Registries; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: De novo lesion; PCI; Repeat revascularization; Restenosis; Stent thrombosis