Short and long-term survival after primary percutaneous coronary intervention in young patients with ST-elevation
Homa Waziri1, Erik Jørgensen1, Henning Kelbæk1
1Department of Cardiology, The Heart Center, Rigshospitalet, University of Copenhagen, Denmark.
Insights
Young patients under 45 with ST-elevation myocardial infarction (STEMI) have an excellent prognosis after primary percutaneous coronary intervention (PCI). Long-term survival exceeds 99%, with no significant difference in outcomes between young men and women.
Area of Science:
- Cardiology
- Clinical Medicine
- Public Health
Background:
- The long-term prognosis for young ST-elevation myocardial infarction (STEMI) patients and gender-based differences remain under-characterized.
- STEMI in individuals aged 45 or younger represents a significant clinical challenge with potential long-term implications.
Purpose of the Study:
- To investigate the long-term prognosis of STEMI patients aged 45 years or younger.
- To analyze gender-specific differences in long-term outcomes among young STEMI survivors.
Main Methods:
- A cohort of 16,685 STEMI patients treated with primary percutaneous coronary intervention (PCI) between 2003 and 2012 was analyzed.
- Data from the Eastern Danish Heart Registry and Swedish Coronary Angiography and Angioplasty Registry provided a follow-up of 67,992 patient-years.
- Patients were stratified into a young group (≤45 years) and an older group for comparative analysis.
Main Results:
- The young STEMI cohort (n=1026) had distinct characteristics, including a higher prevalence of male sex and smoking, and lower rates of hypertension, hyperlipidemia, diabetes, and prior myocardial infarction compared to older patients.
- Young patients demonstrated significantly lower 30-day mortality (adjusted HR=0.26) and long-term mortality (adjusted HR=0.25) compared to older STEMI patients.
- No significant difference in short-term or long-term mortality was observed between women and men within the young STEMI group.
Conclusions:
- STEMI patients aged 45 or younger treated with primary PCI exhibit an excellent long-term prognosis, with an annual survival rate exceeding 99%.
- Young women experiencing STEMI have a comparable long-term prognosis to young men, indicating no adverse gender-specific outcome disparity.
Unlabelled:
The long-term prognosis of patients with ST-elevation myocardial infarction (STEMI) aged 45 years or younger and differences according to gender have not been well characterized.
Methods:
We included 16,685 consecutive STEMI patients from 2003 to 2012 (67,992 patient-years follow-up) from the Eastern Danish Heart Registry and the Swedish Coronary Angiography and Angioplasty Registry who were treated with primary percutaneous coronary intervention (PCI).
Results:
We identified 1026 (6.2%) patients up to 45 years of age (mean age: 40.7 vs. 66.3 years, P<0.001). Patients in the young group were predominantly men (79.7% vs. 71.9%) and smokers (71.2% vs. 44.2%, P<0.001) but with a lower prevalence of hypertension (17.3% vs. 39.3%), hyperlipidemia (18.0% vs. 23.8%), diabetes (9.0% vs. 12.4%) and previous myocardial infarction (6.9% vs. 12.2%, all P<0.001) compared with older patients. Young patients had a 0.8% annual mortality. During the follow-up period 6.3% of young patients died vs. 28.5% of older patients (P<0.001). Both 30-day-mortality (adjusted hazard ratio [HR]=0.26, 95% confidence interval [CI]: 0.12-0.54, P<0.001) and mortality after 30 days and onwards (HR=0.25, CI: 0.17-0.37, P<0.001) were significantly lower in the young group. There was no difference in short-term (HR=0.78, CI: 0.32-1.90, P=0.59) or long-term (HR=0.62, CI: 0.33-1.91, P=0.59) mortality between women and men in the young group (HR=0.79, CI: 0.21-1.80, P=0.39).
Conclusions:
STEMI patients, aged 45 years or younger, have an excellent prognosis after treatment with primary PCI. Long-term annual survival is more than 99% in these patients. Young women with STEMI do not have a worse long-term prognosis than young men with STEMI.
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