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

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. 62.1. years, 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.