Prognosis and disease progression in patients under 50 years old undergoing PCI: The CRAGS (Coronary aRtery diseAse in younG adultS) study

Anna Lautamäki, K. E.Juhani Airaksinen*, Tuomas Kiviniemi, Giulia Vinco, Flavio Ribichini, Jarmo Gunn, Vesa Anttila, Jouni Heikkinen, Kari Korpilahti, Pasi Karjalainen, Olli Kajander, Markku Eskola, Erkki Ilveskoski, Tomas Axelsson, Tomas Gudbjartsson, Anders Jeppsson, Fausto Biancari

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

15 Citations (Scopus)


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. Conclusion: 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.

Original languageEnglish
Pages (from-to)483-487
Number of pages5
Issue number2
Publication statusPublished - 1 Aug 2014

Bibliographical note

Publisher Copyright:
© 2014 Elsevier Ireland Ltd.

Other keywords

  • De novo lesion
  • PCI
  • Repeat revascularization
  • Restenosis
  • Stent thrombosis


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