Key result
Older STEMI phenotypes show higher SYNTAX scores and risk-factor burden than young STEMI without altering in-hospital MACE.
Why the study?
Age-based comparisons in STEMI typically use a binary young-older framework that may obscure premature non-young disease, leaving age-group patterns in risk factors, angiographic complexity, inflammatory-metabolic indices, and in-hospital outcomes in first-presentation STEMI unclear.
Cohort (n=150)
No
In first-presentation STEMI, younger patients predominantly feature smoking and angiographic thrombus with lower coronary complexity, whereas older patients exhibit greater non-smoking modifiable risk factor burden, higher angiographic complexity, and worse inflammatory-metabolic profiles without differences in in-hospital MACE or mortality.
May inform phenotype-specific risk profiling in first-presentation STEMI; leaves open whether targeted strategies improve long-term outcomes.
OBJECTIVE: Age-based comparisons in ST-elevation myocardial infarction (STEMI) often use a binary young-older framework, which may obscure premature non-young disease. We evaluated age-group patterns in measured modifiable risk factors, angiographic complexity, inflammatory-metabolic indices, and in-hospital outcomes in patients presenting with first STEMI. METHOD: This single-center retrospective study screened 421 STEMI records between January 2019 and May 2026. After exclusions, 150 patients were selected from an eligible pool of 229 using sex-stratified, equal-size quota sampling. The groups were defined as young STEMI (≤45 years), premature non-young STEMI (men 46-55 years, women 46-65 years), and older STEMI (men >55 years, women >65 years). Measured four-component standard modifiable cardiovascular risk factor (SMuRF) burden, angiographic findings, SYNTAX score, systemic immune-inflammation index (SII), hemoglobin-albumin-lymphocyte-platelet score (HALP), C-reactive protein/albumin ratio (CAR), mortality, and major adverse cardiovascular events (MACE) were analyzed. Two multivariable models were used to assess age group and SYNTAX score. RESULTS: Smoking prevalence decreased across groups, whereas diabetes, hypertension, hyperlipidemia, and measured four-component SMuRF burden increased with age. Thrombus was most frequently observed in young STEMI. SYNTAX score, multivessel disease, SYNTAX ≥23, SII, and CAR increased with age, whereas HALP decreased. Non-smoking SMuRF burden distinguished premature non-young STEMI and older STEMI from young STEMI; older STEMI was independently associated with a higher SYNTAX score. No significant differences in mortality or MACE were detected. CONCLUSION: In this selected cohort, young STEMI was characterized by smoking predominance, a higher prevalence of angiographic thrombus, and lower coronary complexity, whereas older STEMI showed greater measured four-component SMuRF burden, increased coronary complexity, and less favorable inflammatory-metabolic indices. No differences were detected in in-hospital mortality or MACE.
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Çekin et al. (2026) conducted a cohort in First-presentation ST-elevation myocardial infarction (STEMI) (n=150). Older and premature non-young age phenotypes vs. Young STEMI (≤45 years) was evaluated on Angiographic complexity (SYNTAX score, SYNTAX ≥23), inflammatory-metabolic indices, in-hospital mortality, and major adverse cardiovascular events (MACE). Older STEMI age phenotypes (>55 years in men, >65 in women) had higher SYNTAX ≥23 rates and four-component SMuRF burden than young STEMI (≤45 years), with no differences in in-hospital MACE.
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