Age-stratified Prevalence and Relative Prognostic Significance of Traditional Atherosclerotic Risk Factors: A Report from the Nationwide Registry of Percutaneous Coronary Interventions in Japan

Abstract

Background: The prevalence of traditional atherosclerotic risk factors (TARFs) and their association with clinical profiles or mortality in percutaneous coronary intervention (PCI) remain unclear. Methods: The study analyzed 559,452 patients who underwent initial PCI between 2012 and 2019 in Japan. TARFs were defined male, hypertension, dyslipidemia, diabetes, smoking, and chronic kidney disease (CKD). We evaluated the age-specific prevalence of TARFs, and calculated the relative importance (RI) according to R2, ,machine learning to assess the impact of TARFs on clinical profile (age, the presentation of acute myocardial infarction, cardiogenic shock, and multivessel disease) and in-hospital mortality. The average percentage of the RI calculated from these models was defined as the relative contribution (RC) of each TARF. Results: The age-specific prevalence of TARFs, except for CKD, formed an inverted U-shape with significantly different peaks and percentages. Smoking was more prevalent in patients with ST-elevation myocardial infarction than in patients with stable angina (odds ratio [OR], 1.75, 95% confidence interval [CI], 1.73-1.77). In logistic regression model and relative risk model, smoking was most strongly associated with acute myocardial infarction (AMI) (adjusted OR, 1.62, 95% CI, 1.60-1.64; RC, 47.1%) and premature coronary artery disease (adjusted unstandardized beta coefficient [UC], 2.68, 95% CI, 2.65-2.71, RC, 42.2%). Diabetes was most strongly associated with multivessel disease (adjusted UC, 0.068; 95% CI, 0.066-0.070, RC, 59.4%) and the presentation of non-AMI (adjusted OR, 0.77, 95% CI, 0.76-0.78, RI, 21.9%). The absence of dyslipidemia was most strongly associated with presentation of cardiogenic shock (adjusted OR, 0.62; 95% CI, 0.61-0.64, RC, 34.2%) and in-hospital mortality (adjusted OR, 0.44, 95% CI, 0.41-0.46, RC, 39.8%). These specific associations were consistently observed regardless of adjustment or stratification by age. Conclusions: Our analysis showed a significant variation in the age-specific prevalence of TARFs. Further, their contribution to clinical profiles and mortality also varied widely