Characterization of features and outcomes of young patients (< 45 years) presenting with ST-segment elevation
Ahmad Samir1, Mohammed Almahjori2, Basem Zarif3
1Faculty of Medicine, Cairo University, Cairo, Egypt. ahmadsamir11@cu.edu.eg.
Insights
Younger patients with ST-elevation myocardial infarction (STEMI) have distinct risk factors like smoking and family history but fewer adverse events. Despite better outcomes, 1-year mortality remains similar to older STEMI patients.
Area of Science:
- Cardiology
- Public Health
- Epidemiology
Background:
- Coronary artery disease (CAD) is a leading global cause of death.
- ST-segment elevation myocardial infarction (STEMI) significantly impacts younger individuals psychologically and economically.
- Limited data exists on young STEMI patients in Egypt.
Purpose of the Study:
- To characterize young STEMI patients (≤45 years) in Egypt.
- To compare their features and outcomes against older STEMI patients (>45 years).
- To evaluate 1-year outcomes for both young and older STEMI patient groups.
Main Methods:
- Recruited 492 STEMI patients from National Heart Institute and Cairo University Hospitals.
- Categorized patients into young (≤45 years) and older (>45 years) groups.
- Followed patients for at least 12 months post-event, assessing clinical characteristics and outcomes.
Main Results:
- Young STEMI patients constituted 20% of all cases, predominantly male (87%).
- Younger patients showed higher rates of smoking (72.4%) and family history (13.3%), with lower rates of diabetes, hypertension, and dyslipidemia.
- Younger patients experienced fewer major adverse cardiovascular events (MACE) and heart failure hospitalizations (10.2% vs. 23.9%), but 1-year mortality was similar (3.1% vs. 4.1%).
Conclusions:
- Young STEMI patients exhibit unique profiles, including increased smoking and family history, and reduced conventional risk factors.
- While younger STEMI patients have better short-term outcomes regarding MACE, long-term mortality is comparable to older patients.
- These findings highlight the need for targeted prevention and management strategies for young STEMI populations.
Background:
Coronary artery disease (CAD) is the commonest cause of death worldwide. ST-segment elevation myocardial infarction (STEMI) and its consequences can be devastating particularly at younger age for a bigger impact on the patient's psychology and ability to work. Little is known about the differential features and outcomes of young STEMI patients in Egypt. This study characterized young STEMI patients (≤ 45 years) compared to patients > 45 years and evaluated 1-year outcomes.
Results:
A total of 492 eligible STEMI patients who presented to the National Heart Institute and Cairo University Hospitals were recruited. Young STEMI patients (< 45 years old) represented 20% of all STEMI comers. Male gender was predominant in both groups, yet with a significantly higher proportion in the younger compared to older patients (87% vs. 73%, p = 0.004). Compared to older patients, young STEMI patients had characteristically higher rates of smoking (72.4% vs. 49.7%, p < 0.001) and family history (13.3% vs. 4.8%, p = 0.002), while significantly lower rate of other conventional CAD risk factors as diabetes, hypertension, and dyslipidemia (20.4% vs. 44.7%, 20.4% vs. 44.9% and 12.7% vs. 21.8%, respectively, p < 0.05 for all). Follow-up was continued for at least 12 months after the index event. Younger STEMI patients had fewer major adverse cardiovascular events and fewer heart failure hospitalizations compared to the older controls (10.2 vs. 23.9% and 18.4% vs. 34.8%, respectively, p < 0.005 for both), however, 1-year mortality was similar (3.1% vs. 4.1%, p = 0.64).
Conclusions:
Younger STEMI patients (≤ 45 years) show peculiar characteristics, with significantly higher rates of smoking and family history of premature CAD, while less prevalence of other conventional CAD risk factors. Overall MACE occurred less in younger STEMI patients; however, the mortality rate was similar to the older controls.
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