Clinical profile and impact of family history of premature coronary artery disease on clinical outcomes of patients undergoing primary percutaneous coronary intervention for ST-elevation myocardial infarction: analysis from the HORIZONS-AMI Trial.
BACKGROUND/PURPOSE
Family history of coronary artery disease (CAD) is a well-established risk factor of future cardiovascular events. The authors sought to examine the relationship between family history of CAD and clinical profile and prognosis of patients with ST-elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI).


MATERIALS/METHODS
Baseline features and clinical outcomes at 30 days and at 3 years from 3601 patients with STEMI enrolled in the HORIZONS-AMI trial were compared in patients with and without family history of premature CAD, which was present in 1059 patients (29.4%).


RESULTS
These patients were younger (median 56.7 vs. 62.1years, P<0.0001) and more often current smokers (52.4% vs. 43.5%, P<0.0001), had more dyslipidemia (47.7% vs. 41.1%, P=0.0003), less diabetes mellitus (14.1% vs. 17.5%, P=0.01) and had shorter symptom onset to balloon times (median 213 vs. 225 min, P=0.02). Patients with a family history of premature CAD had higher rates of final TIMI 3 flow (93.8% vs. 90.6%, P=0.002), and myocardial blush grade 2 or 3 (83.2% vs. 78.0% P=0.0008), and fewer procedural complications. Although the unadjusted 30-day and 3-year mortality rates were lower in patients with a family history of premature CAD (1.8% vs. 3.0%, P=0.046 and 4.8% vs. 7.7%, P=0.002, respectively), by multivariable analysis the presence of a family history of premature CAD was not an independent predictor of death at 3 years (HR [95%CI]=1.00 [0.70, 1.44], P=0.98).


CONCLUSIONS
A family history of premature CAD is not an independent predictor of higher mortality.
['Ertelt|Konstanze|K|', 'Généreux|Philippe|P|', 'Mintz|Gary S|GS|', 'Brener|Sorin J|SJ|', 'Kirtane|Ajay J|AJ|', 'McAndrew|Thomas C|TC|', 'Francese|Dominic P|DP|', 'Ben-Yehuda|Ori|O|', 'Mehran|Roxana|R|', 'Stone|Gregg W|GW|']
D000368:Aged D015906:Angioplasty, Balloon, Coronary D002986:Clinical Trials as Topic D003324:Coronary Artery Disease D005260:Female D006801:Humans D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors D008297:Male D008875:Middle Aged D009203:Myocardial Infarction D062645:Percutaneous Coronary Intervention D011379:Prognosis D012307:Risk Factors D015607:Stents D016896:Treatment Outcome
Coronary artery disease Percutaneous coronary intervention Heredity