Acute ST-segment elevation myocardial infarction in young adults: who is at risk?

Less than 10% of patients presenting with acute myocardial infarction (AMI) are young adults. The primary objective of this study was to provide an overview of similarities and dissimilarities among younger and older patients presenting with AMI with the expectation of using the information as an aid in primary and secondary preventions in the future.

From the database of 3527 patients with AMI admitted from January 2001 to December 2008, young adults aged 21-40 years (n = 43) who were diagnosed with ST-segment elevation myocardial infarction were identified. They were then compared with their older counterparts who were admitted from January 2007 to December 2008 subdivided into age groups of 41-60 (n = 86) and 61-80 years (n = 51). Data on clinical cardiovascular risk factors, demographic features, and angiographic findings were gathered and analyzed.

Only 2.58% of ST-segment elevation myocardial infarction patients who were admitted to our hospital over an 8-year period were less than 40 years. Young adults were found to be predominantly male patients (P = 0.04) and had positive family history for coronary artery disease (P = 0.0005). Diabetes and hypertension were less prevalent in the younger group (P = 0.048 and 0.078). Analysis of lipid profile showed comparatively higher total cholesterol, low-density lipoprotein and high-density lipoprotein values in the younger group (≤ P = 0.004). Angiographically, youngsters had propensity toward single-vessel involvement (P = 0.0001).

The risk factor profile and the angiographic involvement differ considerably in the high-risk younger adults and substantiate the need for an aggressive approach directed toward primary and secondary preventions of premature cardiovascular disease.