Premature Acute Myocardial Infarction Treated With Invasive Revascularization: Comparing STEMI With NSTEMI in a
Thomas M Roston1, Vivian Aghanya2, Anamaria Savu2
1Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.
Insights
In young adults, ST-elevation myocardial infarction (STEMI) has higher initial mortality but similar long-term outcomes compared to non-STEMI. Smoking and dyslipidemia are key risk factors in this age group.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Acute myocardial infarction (AMI) typically affects older individuals.
- Limited data exists on demographic and outcome differences between STEMI and NSTEMI in young patients.
Purpose of the Study:
- To compare demographic characteristics and outcomes of STEMI versus NSTEMI in young adults (18-45 years) requiring revascularization.
- To identify risk factors associated with AMI in the young population.
Main Methods:
- Retrospective analysis of 1679 young patients (18-45 years) hospitalized with AMI requiring revascularization in Alberta, Canada.
- Comparison of in-hospital mortality and a composite of heart failure, cardiac arrest, and all-cause mortality at 1 and 5 years post-discharge.
Main Results:
- STEMI was more prevalent (61%) and disproportionately affected males (87.3%).
- Higher in-hospital mortality was observed in STEMI (1.7%) versus NSTEMI (0%) patients.
- One- and 5-year composite outcomes were similar between STEMI and NSTEMI groups after discharge.
Conclusions:
- While STEMI in young patients presents a higher immediate mortality risk and is more common in males, long-term prognosis is comparable to NSTEMI for survivors.
- Dyslipidemia and active smoking are significant risk factors for AMI in young individuals.
Background:
Acute myocardial infarction (AMI) usually presents in older populations, in which there are established demographic and outcome differences for ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI). No similar comparisons for AMI in the young population exist.
Methods:
We compared all index NSTEMI and STEMI hospitalizations in young (18-45 years) patients who required revascularization in Alberta, Canada. Outcomes were survival to discharge, and a composite of heart failure hospitalization, cardiac arrest hospitalization, and all-cause mortality at 1 and 5 years.
Results:
There were 1679 patients included with an index AMI who required revascularization: 655 (39.0%) NSTEMI and 1024 (61.0%) STEMI. The population was disproportionately male (86%), particularly in STEMI patients (87.3%). Marked dyslipidemia (35%) and active smoking (42%) were common, with similar rates among groups. Percutaneous coronary intervention was used in 98.7% of STEMI and 91.5% of NSTEMI patients (P < 0.001), with the remainder who underwent surgical revascularization. The in-hospital mortality rate during index AMI was higher in STEMI compared with NSTEMI patients (1.7% vs 0%; P < 0.001). The rates of the composite outcome were similar for both groups at 1 and 5 years of follow-up in patients who survived to index hospital discharge. After adjusting for sex, age, heart failure and/or cardiac arrest at index AMI, outcomes remained similar among groups at 1 and 5 years.
Conclusions:
In young patients with AMI, STEMI was a disproportionately male phenomenon and associated with higher mortality at index hospitalization. One-year and 5-year outcomes were similar among STEMI and NSTEMI patients in those discharged alive at index AMI. Smoking and dyslipidemia appear to be major risk factors in the young.
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