Acute ST‐elevation Myocardial Infarction in Young Patients: 15 Years of Experience in a Single Center

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Acute ST-elevation Myocardial Infarction (STEMI) (n=849). Intervention: Young age (≤45 years) vs. Older age (>45 years). Primary outcome: In-hospital mortality (p=0.002).

Q: What does this research mean for the field?

Young patients with STEMI have significantly lower in-hospital and long-term mortality compared to older patients, despite having similar rates of reinfarction and repeated PCI. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Su‐Kiat Chua; Huei‐Fong Hung; Kou‐Gi Shyu; Jun‐Jack Cheng; Chiung‐Zuan Chiu; Che‐Ming Chang; Sheng‐Chang Lin; Jer‐Young Liou; Huey‐Ming Lo; Peiliang Kuan; Shih‐Huang Lee

doi:10.1002/clc.20718

March 1, 2010Clinical CardiologyOpen Access

Acute ST‐elevation Myocardial Infarction in Young Patients: 15 Years of Experience in a Single Center

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Key result

Young STEMI patients show ~9 percentage points lower in-hospital mortality compared to older patients.

P=0.002
n=849

Why the study?

Does young age (≤45 years) correlate with different clinical characteristics, angiographic features, and clinical outcomes in patients presenting with STEMI compared to older patients?

Key Points

To investigate the baseline clinical characteristics, coronary angiographic features, and outcomes of young patients presenting with ST-elevation myocardial infarction compared with older patients.
Consecutive cohort study analyzing data from 849 patients with STEMI treated between 1992 and 2006 at a single medical center.
Patients were categorized and compared as young (≤45 years, n=99) or older (>45 years, n=750).
Collected baseline clinical risk factors, coronary anatomy via angiography, in-hospital morbidity and mortality, and long-term outcomes during mean follow-up of 53.4 ± 44.2 months in young patients and 45.5 ± 43.4 months in older patients.
Younger patients had higher rates of smoking (75.8% vs 47.2%, P < 0.001) and obesity (48.2% vs 27.9%, P = 0.002), and were more likely to present with single-vessel disease (56.6% vs 27.6%, P < 0.001).
In-hospital mortality was 3.0% in young patients vs 12.3% in older patients (P = 0.002), and long-term follow-up mortality was 3.0% vs 19.6% (P < 0.001).
Killip class III or IV predicted in-hospital morbidity alone (OR: 31.15, 95% CI: 7.22–137.06, P < 0.001) and combined in-hospital morbidity and mortality (OR: 42.15, 95% CI: 8.13–218.57, P < 0.001) in young patients.

Study Design

Type

Cohort (n=849)

Multicenter

No

Structured PICO

Does young age (≤45 years) correlate with different clinical characteristics, angiographic features, and clinical outcomes in patients presenting with STEMI compared to older patients?

P

Population

849 consecutive patients admitted with acute STEMI to a single center over 15 years, comparing clinical characteristics and outcomes between young (≤45 years) and older (>45 years) adults.

E

Exposure

Young age (≤45 years) at the time of STEMI presentation

C

Comparator

Older age (>45 years) at the time of STEMI presentation

O

Outcome

Length of hospital stay, in-hospital mortality and morbidity, repeated percutaneous coronary intervention (PCI), reinfarction, and mortality during follow-uphard clinical

Main Result

Absolute Event Rate: 3% vs 12.3%

p-value: p=0.002

Young patients presenting with STEMI have a distinct risk profile dominated by modifiable risk factors like smoking, obesity, and dyslipidemia, yet demonstrate significantly better short- and long-term survival compared to older cohorts.

Limitations

Lipid profiles obtained during acute MI may have reduced accuracy due to stress
Observational design where treatment was based on clinical physician judgment
Single-center experience
Lipid profiles assessed during acute index hospitalization, potentially altering true levels due to physiological stress
Treatment was given based on individual physician judgment and experience

Ask about this paper

Answers are grounded in this paper and cite their sources.

Implication

Young STEMI patients had lower mortality; supports modifiable risk factor focus but leaves causal mechanisms open for prospective study.

Abstract

BACKGROUND: There have been few studies done regarding young patients with ST-elevation myocardial infarction (STEMI). The purpose of this study was to investigate the clinical characteristics and coronary angiographic features in young patients with STEMI. METHODS: We collected data on 849 consecutive patients with STEMI from 1992 to 2006. Baseline clinical characteristics, coronary anatomy, and outcome were compared in young (< or =45 yrs) and older patients (>45 yrs). RESULTS: Young patients presented 11.6% of all patients with STEMI. These patients were predominantly male (92.9% vs 80.3%, P < 0.001), more likely to smoke (75.8% vs 47.2%, P < 0.001), obese (48.2% vs 27.9%, P = 0.002), have higher triglyceride levels (176.9 +/- 153.8 mg/dL vs 140.7 +/- 112.7 mg/dL, P = 0.005), and lower high-density lipoprotein cholesterol (37.1 +/- 7.9 mg/dL vs 42.8 +/- 14.3 mg/dL, P = 0.005) than older patients. Also, younger patients had a shorter hospital stay (7.1 +/- 4.9 d vs 8.5 +/- 6.7 d, P = 0.04), less in-hospital morbidity (29.3% vs 39.7%, P = 0.02), and mortality (3.0% vs 12.3%, P = 0.002). Killip class III or IV could predict in-hospital morbidity and mortality in young patients. Both groups had similar rates of repeated percutaneous coronary intervention (PCI; 45.5% vs 41.5%, P = 0.23) and reinfarction (6.1% vs 3.2%, P = 0.32). Mortality rate during follow-up was significantly lower in younger patients (3.0% vs 19.6%, P < 0.001). CONCLUSION: Cigarette smoking, obesity, and dyslipidemia were the most important modifiable risk factors in young patients with STEMI. These patients had a better outcome than older patients without differences in repeated PCI and reinfarction between them. Only Killip class III or IV could predict in-hospital morbidity and mortality in young patients with STEMI.

Discussion

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Cite This Study

Chua et al. (2010) conducted a cohort in Acute ST-elevation Myocardial Infarction (STEMI) (n=849). Young age (≤45 years) vs. Older age (>45 years) was evaluated on In-hospital mortality (p=0.002). Young patients with STEMI had significantly lower in-hospital mortality and long-term overall mortality compared to older patients, despite similar rates of repeat PCI and reinfarction.

synapsesocial.com/papers/6a64cc732c8e24d08564406c https://doi.org/10.1002/clc.20718

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Acute ST‐elevation Myocardial Infarction in Young Patients: 15 Years of Experience in a Single Center

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Acute ST‐elevation Myocardial Infarction in Young Patients: 15 Years of Experience in a Single Center

Key Points

Study Design

Structured PICO

Main Result

Limitations

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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