Clinical Profile and Outcomes of ST-Elevation Myocardial Infarction in Patients Under 45 Years
Matheus Sacco Gomes1, Otávio De Oliveira Marques1, Gregório Furian Rossler Zanchi1
1From the Serviço de Cardiologia, Hospital de Clínicas de Porto Alegre, Porto Alegre, Brazil.
Insights
Young patients with ST-segment elevation myocardial infarction (STEMI) have lower mortality but higher rates of behavioral risk factors like smoking and drug use. Targeted prevention is crucial for improving long-term outcomes in this demographic.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- ST-segment elevation myocardial infarction (STEMI) is a major cause of death globally.
- STEMI incidence is decreasing overall but not in younger populations.
- Understanding modifiable risk factors and outcomes in young STEMI patients is critical.
Purpose of the Study:
- To analyze the clinical profile and outcomes of young STEMI patients.
- To compare young (≤45 years) and older (>45 years) STEMI patients undergoing primary percutaneous coronary intervention.
- To identify risk factors and outcomes in a contemporary cohort.
Main Methods:
- Prospective cohort study of 2050 STEMI patients treated with primary percutaneous coronary intervention.
- Patients stratified into young (≤45 years) and older (>45 years) groups.
- Primary outcome: inhospital mortality. Analyzed clinical characteristics and long-term outcomes.
Main Results:
- Younger STEMI patients (9.3%) had lower inhospital mortality (4.2% vs. 12.1%) and shorter hospital stays.
- Younger patients exhibited higher rates of smoking, illicit drug use, HIV infection, and family history of coronary artery disease.
- Despite fewer comorbidities, young STEMI patients showed a higher prevalence of behavioral risk factors.
Conclusions:
- Young STEMI patients have better inhospital outcomes but present with more behavioral risk factors.
- Findings underscore the need for tailored preventive strategies for young individuals at risk of STEMI.
- Early detection and intervention are essential for improving long-term cardiovascular health in younger populations.
Background:
ST-segment elevation myocardial infarction (STEMI) remains a leading cause of global mortality. Although overall incidence is declining, this trend is less evident among younger individuals, emphasizing the need to better understand modifiable risk factors and clinical outcomes in this population.
Objective:
This study aimed to analyze the clinical profile and outcomes of young patients with STEMI undergoing primary percutaneous coronary intervention in a contemporary cohort.
Methodology:
This prospective cohort study included patients aged ≥18 years with confirmed STEMI treated with primary percutaneous coronary intervention at a tertiary university hospital from March 2011 to January 2025. Patients were stratified into two groups: young (≤45 years) and older (>45 years). The primary outcome was inhospital mortality. A two-sided significance level of P < 0.05 was adopted.
Results:
A total of 2050 patients were included; 191 (9.3%) were ≤45 years old (mean age: 39.9 years). Younger patients showed significantly lower inhospital mortality (4.2% vs. 12.1%; P = 0.001), shorter median length of stay (5 vs. 6 days; P = 0.001), and lower incidence of long-term major adverse cardiovascular and cerebrovascular events (15.2% vs. 24.7%; P = 0.003). They had a higher prevalence of active smoking (57.1% vs. 40.6%; P < 0.001), illicit drug use (18.3% vs. 10.0%; P < 0.001), HIV infection (4.7% vs. 2.2%; P = 0.003), and family history of coronary artery disease (24.2% vs. 12.4%; P < 0.001).
Conclusions:
Young STEMI patients presented with fewer comorbidities and lower inhospital mortality, but a higher prevalence of behavioral risk factors. These findings highlight the need for targeted preventive strategies and early detection to improve long-term outcomes.
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