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Risk Factors and Outcomes of Very Young Adults Who Experience Myocardial Infarction: The Partners YOUNG-MI Registry
Junjie Yang1, David W Biery2, Avinainder Singh3
1Cardiovascular Division, Department of Medicine; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
Insights
Myocardial infarction (MI) rates remain high in young adults. Very young adults (≤40 years) experiencing MI have similar outcomes to those aged 41-50, despite differences in risk factors like substance abuse and hypertension.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Myocardial infarction (MI) rates are not decreasing in young adults despite primary prevention efforts.
- There is a need to understand risk factors and outcomes for very young adults experiencing their first MI.
Purpose of the Study:
- To compare risk factor profiles and outcomes of first-time myocardial infarction (MI) in individuals ≤40 years versus those aged 41-50 years.
- To identify specific differences in risk factors and long-term prognosis between these two young adult MI groups.
Main Methods:
- Retrospective evaluation of patients ≤50 years admitted with Type 1 MI between 2000-2016.
- Analysis of electronic medical records for risk factors and outcomes, including all-cause and cardiovascular mortality.
Main Results:
- Among 2097 young MI patients, 20.5% were ≤40 years.
- Very young MI patients showed higher substance abuse and lower hypertension rates, with increased spontaneous coronary artery dissection.
- Despite these differences, very young MI patients had similar all-cause and cardiovascular mortality over 11.2 years median follow-up.
Conclusions:
- Very young adults (≤40 years) experiencing MI have comparable 1-year and long-term outcomes to those aged 41-50.
- Aggressive secondary prevention strategies are crucial for young myocardial infarction patients.
- Understanding unique risk factors like substance abuse and spontaneous coronary artery dissection in younger MI populations is important.
Background:
Despite significant progress in primary prevention, the rate of myocardial infarction has not decreased in young adults. We sought to compare the risk factor profiles and outcomes between individuals who experienced a first myocardial infarction at a very young (≤40 years) and a young (age 41-50 years) age.
Methods:
We evaluated all patients ≤50 years of age admitted with a Type 1 myocardial infarction to 2 large academic hospitals from 2000 to 2016. Risk factors were determined by review of electronic medical records. The primary outcomes of interest were all-cause and cardiovascular mortality.
Results:
Among 2097 consecutive young patients with myocardial infarction, 431 (20.5%) were ≤40 years of age. When compared with their older counterparts, very young patients had similar risk profiles, with the exception of greater substance abuse (17.9% vs 9.3%, P < .001) and less hypertension (37.9% vs 50.9%, P < .001). Spontaneous coronary artery dissection was more prevalent in very young patients (3.1% vs 1.1%, P = .003). Over a median follow-up of 11.2 years, very young myocardial infarction patients had a similar risk of all-cause and cardiovascular mortality.
Conclusions:
Despite being, on average, 10 years younger and having a lower prevalence of hypertension, very young myocardial infarction patients had similar 1-year and long-term outcomes when compared with those aged 41 to 50 years at the time of their index infarction. Our findings suggest the need for aggressive secondary prevention measures in very young patients who experience a myocardial infarction.
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