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Cardiac magnetic resonance shows increased adverse ventricular remodeling in younger patients after ST-segment
Ruifeng Guo1, Xiao Wang2, Qian Guo1
1Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
Insights
Young patients with ST-segment elevation myocardial infarction (STEMI) experience worse ventricular remodeling after primary percutaneous coronary intervention (PPCI). These younger individuals face a higher risk of adverse remodeling and are less likely to achieve reverse remodeling compared to older patients.
Area of Science:
- Cardiology
- Biomedical Engineering
- Clinical Research
Background:
- Young patients constitute approximately 50% of ST-segment elevation myocardial infarction (STEMI) cases.
- STEMI patients under 60 exhibit a distinct risk profile compared to older individuals.
- The role of ventricular remodeling in age-related disparities post-STEMI remains unclear.
Purpose of the Study:
- To investigate age-related differences in ventricular remodeling following primary percutaneous coronary intervention (PPCI) in STEMI patients.
- To compare adverse and reverse remodeling patterns between young (<60 years) and old (≥60 years) STEMI patients.
- To identify if younger age is a predictor of unfavorable ventricular remodeling post-STEMI.
Main Methods:
- An observational study involving 123 STEMI patients who underwent PPCI.
- Serial cardiovascular magnetic resonance imaging was performed at baseline (3-7 days) and 3 months post-PPCI.
- Adverse remodeling was defined as ≥10% increase in left ventricular end-diastolic volume index (LVEDVi); reverse remodeling as >10% decrease in left ventricular end-systolic volume index (LVESVi).
Main Results:
- Younger patients (n=71) showed a significantly higher incidence of adverse remodeling (49.3% vs 30.8%, p=0.039) and lower reverse remodeling (31.0% vs 53.8%, p=0.011) compared to older patients (n=52).
- Left ventricular end-systolic volume index (LVESVi) significantly decreased only in the older patient group.
- Younger age (<60 years) was independently associated with increased risk of adverse remodeling (aOR 3.51) and decreased likelihood of reverse remodeling (aOR 0.42).
Conclusions:
- Young STEMI patients undergoing PPCI exhibit unfavorable ventricular remodeling compared to older counterparts.
- Younger individuals are at higher risk for adverse remodeling and less likely to achieve reverse remodeling post-STEMI.
- Increased clinical attention and tailored management strategies are warranted for young STEMI patients.
Objectives:
Young patients account for about half of ST-segment elevation myocardial infarction (STEMI) patients and display a unique risk profile compared with old patients. Whether these differences are related to disparities in ventricular remodeling remains unknown. This study aimed to evaluate age-related differences in ventricular remodeling after primary percutaneous coronary intervention (PPCI) for STEMI.
Methods:
In this observational study, consecutive STEMI patients between October 2019 and March 2021 who underwent serial cardiovascular magnetic resonance at index admission (3 to 7 days) and 3 months after PPCI were enrolled. Adverse remodeling was defined as ≥ 10% enlargement in left ventricular end-diastolic volume index (LVEDVi), while reverse remodeling was defined as a decrease in left ventricular end-systolic volume index (LVESVi) of more than 10%.
Results:
A total of 123 patients were included and grouped into young (< 60 years, n = 71) and old (≥ 60 years, n = 52) patients. Despite generally similar baseline structural and infarct characteristics, LVESVi significantly decreased only in old patients during follow-up (p = 0.034). The incidence of adverse remodeling was higher (49.3% vs 30.8%, p = 0.039), while the incidence of reverse remodeling was lower (31.0% vs 53.8%, p = 0.011) in young compared with old patients. Younger age (< 60 years) was associated with a significantly higher risk of adverse remodeling (adjusted OR 3.51, 95% CI 1.41-8.74, p = 0.007) and lower incidence of reverse remodeling (adjusted OR 0.42, 95% CI 0.18-0.97, p = 0.046).
Conclusions:
In STEMI patients undergoing PPCI, young patients are at a higher risk of adverse remodeling and less probably develop reverse remodeling than old patients. Equal or more attention should be paid to young patients with STEMI compared with their older counterparts.
Key Points:
• In STEMI patients undergoing PPCI, young patients displayed unfavorable remodeling compared with old patients. • Young patients are at a higher risk of adverse remodeling and less probably develop reverse remodeling than old patients. • Equal or more attention should be paid to young patients compared with their older counterparts.
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