Clinical Outcomes in Young Patients Undergoing Percutaneous Coronary Intervention.

BACKGROUND

Young adults undergoing percutaneous coronary intervention (PCI) are often perceived as low risk, yet long-term outcome data in this population are limited. Understanding predictors of adverse events in this group may uncover important targets for improving procedural and postprocedural care.

AIMS: To evaluate the incidence and predictors of 12-month mortality and major adverse cardiovascular events (MACE) in a contemporary Australian cohort of young patients undergoing PCI.

METHODS

We analyzed data from the Victorian Cardiac Outcomes Registry (VCOR), a multicenter state-wide PCI registry, including all patients aged 18-55 years who underwent PCI between 2014 and 2023. Patients with out-of-hospital cardiac arrest or cardiogenic shock were excluded. The primary outcome was 12-month all-cause mortality; secondary outcomes included in-hospital events and 30-day major adverse cardiovascular events (MACE).

RESULTS

Among 16,410 patients, most were aged 45-55 (n = 13,188/16,410; 80.4%), and the majority presented with acute coronary syndromes (n = 10,792/16,410; 65.8%). The 12-month mortality was 1.0%, with no difference across age subgroups. Independent predictors for long-term mortality included eGFR ≤ 30 (HR 6.99; 95% CI 4.98-9.80), left ventricular ejection fraction < 35% (HR 5.35; 95% CI 4.01-7.13), diabetes (HR 1.65; 95% CI 1.33-2.03), and female sex (HR 1.42; 95% CI 1.14-1.78). Use of dual antiplatelet therapy at 30 days was lower in those who died (49.4% vs. 88.9%, p < 0.001). Procedural factors such as femoral access and use of bare-metal stents were also more common in this group. Stent thrombosis, stroke, and major bleeding were disproportionately represented among those who died.

CONCLUSION

Although 12-month mortality after PCI in young adults is low, patients with comorbidities such as diabetes, chronic kidney disease, and left ventricular dysfunction experience disproportionately worse outcomes. These findings highlight the need for improved adherence to evidence-based secondary prevention in this high-risk subset.