What is the clinical evidence from this study?

Study design: Cohort. Population: Acute myocardial infarction (n=213297). Intervention: Cardiopulmonary arrest (CPA) at presentation vs. No cardiopulmonary arrest. Primary outcome: In-hospital mortality (OR 14.2, 95% CI 9.2-21.9, p=<0.001).

July 5, 2022Open Access

Clinical Presentation and In-Hospital Outcomes of Acute Myocardial Infarction in Young Patients

Q: What are the key findings of this study?

In young patients with acute myocardial infarction, concomitant cardiopulmonary arrest at presentation was strongly associated with increased in-hospital mortality (OR 14.2).

Key Result

In young patients with acute myocardial infarction, concomitant cardiopulmonary arrest at presentation was strongly associated with increased in-hospital mortality (OR 14.2).

Study Design

Type

Cohort (n=213,297)

Multicenter

Yes

Structured PICO

Does younger age affect the clinical presentation and in-hospital mortality in patients undergoing primary PCI for acute myocardial infarction?

Population

213,297 patients aged 20 to 79 years with acute myocardial infarction who underwent primary percutaneous coronary intervention in Japan.

Exposure

Younger age (20 to 49 years) at the time of primary PCI for AMI

Comparator

Older age (50 to 79 years) at the time of primary PCI for AMI

Outcome

Presentation with cardiopulmonary arrest (CPA) and in-hospital mortality within 30 days after PCIhard clinical

Despite having fewer traditional comorbidities, young patients with AMI have a higher risk of presenting with cardiopulmonary arrest, which dramatically increases their in-hospital mortality.

Main Result

Odds Ratio: 14.2 (95% CI 9.2–21.9)

Absolute Event Rate: 14% vs 0.46%

p-value: p=<0.001

Limitations

Only patients who underwent PCI were eligible for enrollment, potentially excluding critically ill patients who did not undergo PCI
Lack of data on oral contraceptive use, drug abuse, and history of Kawasaki disease
Lack of data on obesity and family history of premature AMI
Potential sex-based differences in revascularization procedures

Abstract

Background: Acute myocardial infarction (AMI) in young patients is a concerning issue because of its adverse health and social impacts. Nevertheless, risk factors and prognosis of AMI in young patients are yet to be characterized. Objectives: This study aimed to characterize AMI in young patients who underwent primary percutaneous coronary intervention (PCI) using large-scale nationwide all-comer registry data in Japan, the Japanese Percutaneous Coronary Intervention (J-PCI). Methods: This retrospective cohort study evaluated the J-PCI registry data of patients with AMI aged 20 to 79 years who underwent primary PCI between January 2014 and December 2018. Data on risk factor profiles, clinical features, post-procedural complications, and in-hospital outcomes were reviewed. Results: Among 213,297 patients with AMI who underwent primary PCI, 23,985 (11.2%) were young (ages 20 to 49 years). Compared with the older group (ages 50 to 79 years; n = 189,312), the younger group included a higher number of men, smokers, patients with dyslipidemia, and patients with single-vessel disease, and a lower number of patients with hypertension and diabetes. Despite favorable clinical profiles, younger age was associated with a higher rate of presentation with cardiopulmonary arrest (CPA). Further, concomitant CPA was strongly associated with in-hospital mortality in young patients (odds ratio: 14.2; 95% CI: 9.2 - 21.9). Conclusions: Younger patients with AMI presented a higher risk of CPA, which was strongly associated with in-hospital mortality. The results of this study highlight the importance of primary AMI prevention strategies in young individuals.

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