Young hearts, old challenges: analyzing stemi under 50

Abstract Introduction Acute ST segment elevation myocardial infarction (STEMI) remains a leading cause of premature mortality and morbidity, even in younger patients (pts), with an important loss of quality adjusted life years. Recent studies have tried to identify specific characteristics of young pts with STEMI to help stratify risk factors and optimize prevention measures. Purpose To characterize and evaluate outcomes in a population of young pts with STEMI. Methods Retrospective, single-center study of consecutive pts, with age below 50 years, who were admitted with STEMI and underwent percutaneous coronary intervention (PCI), between 2017 and 2021. Demographics, clinical characteristics, and clinical outcomes, including major cardiovascular events (MACE) and mortality, were analyzed. Multivariable cox proportional hazard model was performed to identify predictors of long-term prognosis. Results We included 257 pts, 82,5% were men, with a mean age of 44.4 ± 4.9 years. 73% of pts were smokers, a 7 fold increase when compared with Portuguese populational data regarding smoking habits. 63% of pts had dyslipidemia, with a mean cLDL of 120 ± 41mg/dL. 39,6% of pts were overweight, with a BMI ≥ 25. Regarding other risk factors, 35% of pts had arterial hypertension and 15% were diabetic. Most pts had STEMI presentation in class 1 of the Killip-kimball classification, with only 4 presenting with Killip 4. The majority of pts had one vessel disease and were submitted to angioplasty with coated stent implantation, with the anterior descendent coronary artery (CA) and right CA identified as culprit lesions in 58% and 28% of pts, respectively. During a mean follow-up (FUP) of 2.9 ± 1.4 years, 16 pts died, 12 of which within the first 30 days. 27 pts developed heart failure, 18 suffered reinfarction and 7 were admitted with stroke. In our analysis, ejection fraction (EF) at presentation (mean 48.9 ±11%) was the only variable associated with MACE and mortality during FUP (p0.001). Conclusion Despite having an apparently more benign initial presentation, STEMI in young pts is associated with high risk mortality and MACE. Close follow-up and risk factor management have a major role, particularly in this population.