Characteristics and outcomes of young patients with ST segment elevation myocardial infarction undergoing primary
Benjamin Wl Tung1,2, Zhe Yan Ng3, William Kristanto3,4
1Cardiology, National University Heart Centre, Singapore benjamin_wl_tung@nuhs.edu.sg.
Insights
Young patients experiencing ST segment elevation myocardial infarction (STEMI) have distinct risk factors and lower mortality than older patients. Public health initiatives should target these factors to reduce STEMI burden in younger populations.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- ST segment elevation myocardial infarction (STEMI) significantly impacts life years, particularly in younger individuals.
- Primary percutaneous coronary intervention (PPCI) is a key treatment for STEMI.
Purpose of the Study:
- To compare characteristics and outcomes of young (<50 years) versus older (≥50 years) STEMI patients undergoing PPCI.
- To inform public health strategies for STEMI prevention.
Main Methods:
- Retrospective review of the Coronary Care Unit database at National University Hospital, Singapore (July 2015 - June 2019).
- Patients were stratified into young (<50 years) and older (≥50 years) groups.
Main Results:
- Of 1818 STEMI patients undergoing PPCI, 25.6% were <50 years old.
- Young STEMI patients were more likely male, current smokers, of Indian ethnicity, with a family history of ischaemic heart disease (IHD).
- One-year mortality was lower in young patients (3.4%) vs. older patients (10.4%, p<0.0001). Age predicted mortality in older patients; diabetes showed a trend in both groups.
Conclusions:
- Young STEMI patients present with specific risk factors including smoking, Indian ethnicity, and family history of IHD, alongside prevalent cardiometabolic risks.
- While mortality is lower in younger STEMI patients, it is not insignificant, necessitating targeted public health interventions.
- Reducing the prevalence of identified risk factors in susceptible young populations is crucial for STEMI prevention.
Objective:
ST segment elevation myocardial infarction (STEMI) is associated with significant mortality leading to loss of productive life years, especially in younger patients. This study aims to compare the characteristics and outcomes of young versus older patients with STEMI undergoing primary percutaneous coronary intervention (PPCI) to help focus public health efforts in STEMI prevention.
Methods:
Data from the Coronary Care Unit database of the National University Hospital, Singapore from July 2015 to June 2019 were reviewed. Patients were divided into young (<50 years old) or older (≥50 years old) groups.
Results:
Of the 1818 consecutive patients with STEMI who underwent PPCI, 465 (25.6%) were <50 years old. Young compared with older patients were more likely to be male, current smokers, of Indian ethnicity, have family history of ischaemic heart disease (IHD) and had lower 1 year mortality (3.4% vs 10.4%, p<0.0001). Although diabetes, hypertension or dyslipidaemia was less common among young patients, the prevalence of having any one of these risk factors was high in the range of 28% to 38%. Age was an independent predictor of mortality in the older but not younger patients with STEMI, and diabetes showed a trend towards mortality in both groups.
Conclusion:
Young patients with STEMI are more often smokers, of Indian ethnicity and had family history of IHD, although cardiometabolic risk factors are also prevalent. Mortality is lower, but not negligible, among the young patients with STEMI. Public health efforts are needed to reduce the prevalence of these risk factors among the constitutionally susceptible population.
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