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Long-Term Prognosis after ST-Elevation Myocardial Infarction in Patients with Premature Coronary Artery Disease

Lidija Savic1,2, Igor Mrdovic1,2, Milika Asanin1,2

  • 1Faculty of Medicine, University of Belgrade, 11000 Beograd, Serbia.

Journal of Personalized Medicine
|March 28, 2024
PubMed

Insights

Younger patients with ST-elevation myocardial infarction (STEMI) and premature coronary artery disease (CAD) experienced lower mortality and major adverse cardiovascular events (MACEs). However, reduced ejection fraction (EF < 40%) independently predicted worse outcomes in this group.

Area of Science:

  • Cardiology
  • Cardiovascular Research
  • Interventional Cardiology

Background:

  • Premature coronary artery disease (CAD) affects a significant percentage of younger patients experiencing myocardial infarction.
  • Understanding the long-term outcomes of ST-elevation myocardial infarction (STEMI) in patients with premature CAD is crucial for risk stratification and management.

Purpose of the Study:

  • To evaluate eight-year all-cause mortality and major adverse cardiovascular events (MACEs) in STEMI patients with premature CAD.
  • To identify predictors of mortality and MACEs in this specific patient cohort.

Main Methods:

  • Analysis of 2560 STEMI patients without prior CAD or cardiogenic shock, treated with primary percutaneous coronary intervention (PCI).
  • Premature CAD defined as <50 years for men and <55 years for women.
  • Eight-year follow-up for mortality and MACEs (cardiovascular death, non-fatal reinfarction, stroke, target vessel revascularization).

Main Results:

  • Premature CAD was identified in 24.6% of patients, presenting with fewer comorbidities and better initial angiographic findings.
  • The incidence of non-fatal ischemic events was comparable to older patients.
  • Premature CAD independently predicted lower mortality (HR 0.50) and MACEs (HR 0.27).
  • In patients with premature CAD, an ejection fraction (EF) < 40% was the sole independent predictor of mortality (HR 5.59) and MACEs (HR 4.18).

Conclusions:

  • Premature CAD is an independent protective factor against long-term mortality and MACEs following STEMI.
  • Reduced ejection fraction (EF < 40%) is a significant independent predictor of adverse outcomes in STEMI patients with premature CAD.
Abstract

Keywords:
ST-elevation myocardial infarctionpredictorspremature coronary artery diseaseprognosis

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