Premature Acute Myocardial Infarction Treated with Invasive Revascularization: Comparing STEMI to NSTEMI in a Population-Based Study of Young Patients.

BACKGROUND

Acute myocardial infarction (AMI) usually presents in older populations, where there are established demographic and outcome differences between ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). No similar comparisons for young AMI exist.

METHODS

We compared all index NSTEMI and STEMI hospitalizations in the young (18-45 years) requiring revascularization in Alberta, Canada. Outcomes were survival to discharge, and a composite of heart failure hospitalization, cardiac arrest hospitalization, and all-cause mortality at 1- and 5-years.

RESULTS

There were 1679 patients included with an index AMI requiring revascularization (655 (39.0%) NSTEMI and 1024 (61.0%) STEMI). The population was disproportionately male (86%), particularly in STEMI (87.3%). Marked dyslipidemia (35%) and active smoking (42%) were common, with similar rates between groups. Percutaneous coronary intervention was used in 98.7% of STEMI and 91.5% of NSTEMI patients (P<0.001), with the remainder undergoing surgical revascularization. In-hospital mortality during index AMI was higher STEMI compared to NSTEMI patients (1.7% vs 0%, P<0.001). The rates of the composite outcome were similar between groups at 1- and 5-years of follow-up in patients who survived to index hospital discharge. After adjusting for sex, age, heart failure and/or cardiac arrest at index AMI, outcomes remained similar between groups at 1- and 5-years.

CONCLUSIONS

In young patients with AMI, STEMI was a disproportionately male phenomenon and associated with higher mortality at index hospitalization. One-year and 5-year outcomes were similar between STEMI and NSTEMI in those discharged alive at index AMI. Smoking and dyslipidemia appear to be major risk factors in the young.

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Copyright © 2024. Published by Elsevier Inc.