Journal Article

Characteristics and Outcomes of Young Patients With ST-Elevation Myocardial Infarction Without Standard Modifiable Risk Factors

Rankin, James M., Dwivedi, Girish, Hng, Cherng, Ihdayhid, Abdul Rahman, Schultz, Carl J., Kelly, Ciaran, Lan, Nick S.R., Reid, Christopher M., Figtree, Gemma A., Phan, Jane, Hillis, Graham S., Matthews, Amy

2023

Overview

Patients with ST-elevation myocardial infarction (STEMI) with no standard modifiable risk factors (SMuRFs: hypertension, diabetes mellitus, hypercholesterolemia, and smoking) have worse short-term mortality than those with SMuRFs. Whether this association extends to younger patients is unclear. A retrospective cohort study was performed of patients aged 18 to 45 years with STEMI at 3 Australian hospitals between 2010 and 2020. Nonatherosclerotic causes of STEMI were excluded. The primary outcome was 30-day all-cause mortality. Secondary outcomes included 1 and 2-year mortality. Cox proportional hazards analysis was used. Of 597 patients, the median age was 42 (interquartile range 38 to 44) years, 85.1% were men and 8.4% were SMuRF-less. Patients who are SMuRF-less were >2 times more likely to have cardiac arrest (28.0% vs 12.6%, p = 0.003); require vasopressors (16.0% vs 6.8%, p = 0.018), mechanical support (10.0% vs 2.3%, p = 0.046), or intensive care admission (20.0% vs 5.7%, p <0.001); and have higher rate of left anterior descending artery infarcts than those with SMuRFs (62.0% vs 47.2%, p = 0.045). No significant differences in thrombolysis or percutaneous intervention were observed. Guideline-directed medical therapy at discharge was high (>90%), and not different in the SMuRF-less. 30-day mortality was almost fivefold higher in the SMuRF-less (hazard ratio 4.70, 95% confidence interval 1.66 to 13.35, p = 0.004), remaining significant at 1 and 2 years. In conclusion, young patients who are SMuRF-less have a higher 30-day mortality after STEMI than their counterparts with SMuRFs. This may be partially mediated by higher rates of cardiac arrest and left anterior descending artery territory events. These findings further highlight the need for improved prevention and management of SMuRF-less STEMI.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Adult / Alcohol / Angioplasty / Australia - epidemiology / Cardiovascular disease / Chi-square test / Coronary vessels / Diabetes / Diabetes mellitus / Drug use / Female / Heart / Heart Arrest - etiology / Heart attacks / Hemoglobin / Humans / Hypercholesterolemia / Hypertension / Male / Medical imaging / Medical records / Metabolic disorders / Mortality / Myocardial infarction / Patients / Percutaneous Coronary Intervention - adverse effects / Percutaneous treatment / Retrospective Studies / Risk Factors / Smoking / ST Elevation Myocardial Infarction - epidemiology / ST Elevation Myocardial Infarction - etiology / ST Elevation Myocardial Infarction - therapy / Thrombolysis / Thrombolytic drugs / Treatment Outcome