What does this research mean for the field?

In patients with premature acute myocardial infarction, multivessel disease significantly predicts higher risks of major adverse cardiovascular events and recurrent myocardial infarction compared to older patients. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

What question did this study set out to answer?

This research aims to assess the long-term prognosis of premature acute myocardial infarction and the specific impact of multivessel coronary artery disease on outcomes.

January 22, 2026

Long-term outcomes of premature acute myocardial infarction: impact of multivessel disease

Key Result

In patients with premature AMI, multivessel disease significantly predicted higher risks of MACE (sHR 2.46) and recurrent MI (sHR 3.34) compared to older patients.

Key Points

This research aims to assess the long-term prognosis of premature acute myocardial infarction and the specific impact of multivessel coronary artery disease on outcomes.
Analyzed patients undergoing percutaneous coronary intervention from a multicenter registry.
Focused on patients aged 45 or younger with a follow-up period extending to October 2019.
Primary outcome measured was major adverse cardiovascular events using multivariable hazard models.
Conducted sensitivity analyses to ensure robustness of findings.
Of 10,144 AMI patients, 907 were identified with premature AMI.
Premature AMI was not associated with reduced risk of major adverse cardiovascular events compared to older patients.
34.3% of premature AMI patients had multivessel disease, predicting significantly higher risks for major adverse cardiovascular events and recurrent myocardial infarction.
Findings suggest the need for intensified secondary prevention strategies in younger patients with multivessel disease.

Structured PICO

Does premature AMI and the presence of multivessel disease impact the long-term risk of MACE compared to older AMI patients?

Population

10,144 consecutive acute myocardial infarction (AMI) patients undergoing percutaneous coronary intervention who survived to discharge (excluding in-hospital death), including 907 with premature AMI (age ≤ 45 years, mean age 40.4, 94.3% male).

Intervention

Premature AMI (age ≤ 45 years) and presence of multivessel coronary artery disease

Comparator

Older AMI patients (age > 45 years)

Outcome

Major adverse cardiovascular events (MACE, a composite of recurrent myocardial infarction, stroke, or repeat revascularization)composite

Patients with premature AMI face long-term ischemic risks comparable to older patients, with multivessel disease acting as a particularly strong predictor of adverse events in this younger demographic.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Background Premature acute myocardial infarction (AMI) is increasingly prevalent yet underrepresented in trials. We aimed to evaluate the prognosis of premature AMI and the prognostic impact of multivessel coronary artery disease. Methods We analyzed consecutive AMI patients undergoing percutaneous coronary intervention in the multicenter Cardiovascular Risk and Identification of Potential High-Risk Population in AMI registry between April 2001 and April 2015, with follow-up through October 2019. Patients with premature AMI (age ≤ 45 years) were analyzed, and those who experienced in-hospital death were excluded. The primary outcome was major adverse cardiovascular events (MACE, a composite of recurrent myocardial infarction (MI), stroke, or repeat revascularization). Risks of ischemic outcomes were evaluated using multivariable Fine-Gray subdistribution hazard models. Sensitivity analyses included cause-specific Cox regression and multiple-imputation Cox models, accounting for competing risks. Results Of the 10 144 AMI patients, 907 (8.9%) had premature AMI (mean 40.4 years; 94.3% male). Compared with older patients, premature AMI was not associated with lower risk of MACE adjusted subdistribution hazard ratio (sHR) 1.01, 95% confidence interval (CI): 0.84–1.21, recurrent MI (adjusted sHR 1.49, CI: 1.07–2.06), and repeat revascularization (adjusted sHR 1.16, 95% CI: 0.95–1.44), despite fewer comorbidities. Findings were consistent across sensitivity analyses. In premature AMI, 34.3% had multivessel disease, which independently predicted higher risks of MACE (sHR 2.46), recurrent MI (sHR 3.34), and repeat revascularization (sHR 2.46) compared with older patients (sHR 1.47, 1.22, 1.61, respectively) with significant age-by-multivessel interactions. Conclusion Premature AMI exhibited sustained long-term ischemic risk despite favorable baseline profiles. Multivessel disease conferred a greater prognostic impact in younger patients, highlighting the need for intensified secondary prevention strategies. Given the extended inclusion period encompassing major therapeutic advances, these findings should be interpreted with caution and warrant validation in contemporary clinical practice. Registration: https://www.clinicaltrials.gov; unique identifier: NCT02806102.

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