The aim was to assess coronary artery disease (CAD) risk factor distribution and long-term outcomes in young patients undergoing percutaneous coronary intervention (PCI) in Macedonia. A total of 12,361 PCI patients (from March 2011 to December 2017) were included in the study. Group 1 included 309 young patients aged ≤40 as the main study group, comparing them to 12,052 older PCI patients (group 2) during the study period. We compared CAD risk factor distribution, clinical and procedure characteristics. Additionally, angiographic data, long-term major adverse cardiac and cerebrovascular events (MACCE) and mortality were analyzed in group 1 patients. Median age was 36±4 years in group 1 and 62±11 years in group 2. Male patients predominated in both groups (88% vs.73%). Positive family history for CAD, smoking and obesity was much more common in the young group (p<0.0001). ST segment elevation myocardial infarction (STEMI) primary PCI was also more frequent with 48% of PCI in the young group (p<0.0001). Multivessel CAD and chronic total occlusion interventions were more common in the older group (51% and 28%, respectively; p<0.0001). Procedure duration (31±0.4 vs. 35±22 min) and fluoroscopy time (9±4 vs. 9±12 min) were similar in both groups. There was no difference in access site bleeding (4.8% vs. 4.3%). During the 3.5-year median follow up, MACCE was present in 1.9% of young patients. In conclusion, positive family history for CAD, obesity and smoking were the most common risk factors in the young PCI population. Young PCI patients usually had single vessel CAD with STEMI being more frequent as the cause for primary PCI. Long-term annual survival exceeded 99% in these patients with excellent prognosis after PCI.

Clopidogrel has an antiplatelet effect, which is used to reduce the risk of myocardial infarction and stroke in high-risk patients in the context of primary prophylaxis. In the body it is subjected to metabolism by the liver enzyme system CYP450.In this project, laboratory conditions have been established to determine the polymorphisms of the CYP450 2C19 gene.The structure of the polymorphisms in the CYP450 2C19 gene and the type of metabolizer has been determined.This study included 42 heart patients with St. post PCI, mean age 65-9.7 years, treated with 75 mg Clopidogrel daily.The following polymorphisms were examined: c.681G> A; c.636G> A; c.1A> G; c.1297C> T; c.395G> A; c.819 + 2T> A; c.358T> C; c.-806C> T.Appropriate laboratory conditions have been established for the precise determination of polymorphisms in the CYP450 2C19 gene and the determination of the type of metabolizer.The results showed that in our patients the largest number of polymorphisms occur at the position c.681G> A which leads to the creation of an intermediate metabolizer, while the polymorphism at the position c.-806C> T leads to the creation of an ultrafast metabolite.The largest number of polymorphisms occurs in c.681G> A CYP450 2C19 gene, which leads to the creation of an intermediate metabolizer.Because of this, and before starting the therapy in patients St. post PCI, it is necessary to first determine what clopidogrel metabolizers they are and whether they possess LF or GF alleles.

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