Key result
In young adults with ACS, STEMI was associated with higher hospital MACCE (HR 4.65; 95% CI 2.45-8.82), but non-STEMI patients had a higher risk of MACCE after 3 years (14.4% vs 9.9%).
Why the study?
Coronary artery disease prevalence is increasing in young adults, motivating an evaluation of outcomes across different types of acute coronary syndrome in this population.
Does STEMI compared to non-STEMI affect short- and long-term outcomes in young patients (≤45 years) with acute coronary syndrome?
Cohort (n=917)
Does STEMI compared to non-STEMI affect short- and long-term outcomes in young patients (≤45 years) with acute coronary syndrome?
Hazard Ratio: 4.65 (95% CI 2.45–8.82)
Absolute Event Rate: 13.8% vs 3.3%
p-value: p=<.001
In young patients with acute coronary syndrome, STEMI is associated with higher in-hospital mortality and MACCE, whereas non-STEMI is associated with a higher risk of long-term MACCE.
STEMI, heart failure, and contrast-induced nephropathy flag higher MACCE risk in young ACS; hypothesis-generating and requires prospective validation.
The prevalence of coronary artery disease is increasing in young adults. We evaluated the outcomes of different types of acute coronary syndrome in 917 patients undergoing coronary angiography aged ≤45 years. Male sex, smoking, dyslipidemia were the most important risk factors. ST-elevation myocardial infarction (STEMI; 54.8%) predominated. The STEMI patients had higher risk of hospital mortality (3.6% vs 0.6%; P = .004) and major adverse cardiac and cerebrovascular events (MACCE; 13.8% vs 3.3%; P < .001, hazard ratio [HR], 4.65; 95% CI, 2.45-8.82). Presentation heart rate, blood pressure, heart failure, shock, arrhythmia, ejection fraction (EF), diabetes, contrast-induced nephropathy (CIN), and elevated troponin were associated with hospital mortality and MACCE. But only heart failure (HR, 5.816; 95% CI, 2.254-15.008) and CIN (HR, 6.241; 95% CI, 2.340-16.641) were independent risk factors for hospital MACCE. There was no difference in long-term mortality between the 2 groups, but non-STEMI patients had higher risk for MACCE after 3 years (14.4% vs 9.9%, P = .033). Although shock (HR, 0.814; 95% CI, 0.699-0.930), Killip class ≥2 (HR, 0.121; 95% CI, 0.071-0.170), CIN (HR, 0.323; 95% CI, 0.265-0.380), and EF (HR, 0.917; 95% CI, 0.854-0.984) were independent predictors of hospital death, only EF was the independent predictor of long-term mortality (HR, 0.897; 95% CI, 0.852-0.944).
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Yılmaz et al. (2020) conducted a cohort in acute coronary syndrome (n=917). ST-elevation myocardial infarction (STEMI) vs. Non-STEMI was evaluated on hospital major adverse cardiac and cerebrovascular events (MACCE) (HR 4.65, 95% CI 2.45-8.82, p=<.001). In young adults with ACS, STEMI was associated with higher hospital MACCE (HR 4.65; 95% CI 2.45-8.82), but non-STEMI patients had a higher risk of MACCE after 3 years (14.4% vs 9.9%).