Characterization of features and outcomes of young patients (< 45 years) presenting with ST-segment elevation myocardial infarction

Abstract

Background Coronary artery disease (CAD) is the commonest cause of death worldwide. ST-segment elevation myocardial infarction (STEMI) and its consequences can be devastating particularly at younger age for a bigger impact on the patient’s psychology and ability to work. Little is known about the differential features and outcomes of young STEMI patients in Egypt. This study characterized young STEMI patients (≤ 45 years) compared to patients &gt; 45 years and evaluated 1-year outcomes. Results A total of 492 eligible STEMI patients who presented to the National Heart Institute and Cairo University Hospitals were recruited. Young STEMI patients (&lt; 45 years old) represented 20% of all STEMI comers. Male gender was predominant in both groups, yet with a significantly higher proportion in the younger compared to older patients (87% vs. 73%, p = 0.004). Compared to older patients, young STEMI patients had characteristically higher rates of smoking (72.4% vs. 49.7%, p &lt; 0.001) and family history (13.3% vs. 4.8%, p = 0.002), while significantly lower rate of other conventional CAD risk factors as diabetes, hypertension, and dyslipidemia (20.4% vs. 44.7%, 20.4% vs. 44.9% and 12.7% vs. 21.8%, respectively, p &lt; 0.05 for all). Follow-up was continued for at least 12 months after the index event. Younger STEMI patients had fewer major adverse cardiovascular events and fewer heart failure hospitalizations compared to the older controls (10.2 vs. 23.9% and 18.4% vs. 34.8%, respectively, p &lt; 0.005 for both), however, 1-year mortality was similar (3.1% vs. 4.1%, p = 0.64). Conclusions Younger STEMI patients (≤ 45 years) show peculiar characteristics, with significantly higher rates of smoking and family history of premature CAD, while less prevalence of other conventional CAD risk factors. Overall MACE occurred less in younger STEMI patients; however, the mortality rate was similar to the older controls.

Sex-Age Interplay Among Young Aged Egyptians With First Acute Myocardial Infarction

“…In the current study, obesity and dyslipidemia, followed by smoking, were the most prevalent risks for AMI, while HTN was the least in the young population (≤45 years) in concordance with results of Egypt Cardiorisk project Phase 1 and II, 8,9 and with Samir et al 12 The authors and Reda et al 8,9 found that smoking (which was heavy for long duration) was more in males, while obesity with associating dyslipidemia and impaired glucose metabolism were more in females. All these data were consistent with GRACE, Gulf RACE, and Gulf RACE-2, 11 but contrary to INTERHEART 2 studies, which reported a higher prevalence of HTN and DM in younger ages.…”

Predictive value of CHA2DS2VASC score for contrast-induced nephropathy after primary percutaneous coronary intervention for patients presenting with acute ST-segment elevation myocardial infarction

“…Considering STEMI patients, expediting reperfusion is a priority to maximize myocardial salvage and minimize rates of post-MI adverse sequelae, particularly in populations with ≥ 20% of STEMI patients are in the middle age active family earners [ 34 ]. Once STEMI diagnosis is established, the contemporary evidence prioritizes prompt reperfusion by pPCI over any delays (for echocardiography, cardiac troponin or any routine laboratory workup including kidney function tests) [ 6 ].…”

Clinical Characteristics and Outcomes of ST-Elevation Myocardial Infarction in Young Patients: A Single-Center Experience

“…The definition of 'young' in the context of AMI varies, with thresholds set at ≤40, ≤45, or ≤55 years of age [ 3 ]. While ≤45 years is generally the most accepted cutoff, the definition of premature CAD in family histories often extends to MI occurring at ≤55 years or ≤65 years for male and female relatives, respectively [ 4 ].…”