Abstract 225: Prognostic Markers in Young Patients with Premature Coronary Heart Disease

Abstract

Introduction. So far little is known on the prognosis of young patients with coronary heart disease (CHD) and possible predictors of recurrent events. Therefore, we aimed to evaluate the survival and prognostic implications of traditional cardiovascular risk factors and inflammatory and prothrombotic markers in patients with premature CHD. Methods. We obtained follow-up data from 353 young patients with a first cardiac event (men ≤ 45 years and women ≤ 55 years). Baseline characteristics on traditional cardiovascular risk factors were collected at the time of the first event, and levels of C-reactive protein (CRP), von Willebrand Factor (VWF), and fibrinogen were measured one to three months after the first event to exclude an acute phase response. We performed age and sex adjusted Cox’ regression analyses to assess the relationship between these markers and recurrent events (presented as hazard ratios (HR) with 95% confidence intervals). We used three different endpoints: all cause mortality, recurrent cardiac event (myocardial infarction or revascularisation procedure), and any recurrent event (cardiac event, cerebrovascular event or all cause mortality). Results. During a total follow-up time of 1483 person years (mean 4.2 years), 42 patients had a recurrent cardiac event (12%), 11 patients died (3%), and two patients had a cerebrovascular event (<1%). Traditional risk factors were not more frequent among patients with a recurrent event than among patients without a recurrent event. However, CRP was associated with an increased risk of any recurrent event (1.27 [1.01-1.59] per unit increase in lnCRP). Also, both CRP and fibrinogen were associated with all cause mortality. The HR for all cause mortality was 5.00 [1.04-24.04] for CRP levels above the 50 th percentile and 5.04 [1.05-24.2] for fibrinogen levels above the 50 th percentile. VWF levels were not associated with recurrent events. Conclusions. Fifteen percent of young patients with a first cardiac event have a recurrent event or die after a median follow-up of 4.2 years. Elevated levels of CRP and fibrinogen are associated with the risk of recurrent events in these young patients.