Premature Acute Myocardial Infarction Treated With Invasive Revascularization: Comparing STEMI With NSTEMI in a Population-Based Study of Young Patients.

Autor: Roston TM; Department 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., Aghanya V; The Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada., Savu A; The Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada., Fordyce CB; Division of Cardiology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada., Lawler PR; Peter Munk Cardiac Centre, Division of Cardiology and Interdepartmental Division of Critical Care Medicine, University of Toronto, Toronto, Ontario, Canada, and McGill University Health Centre, Montreal, Quebec, Canada., Jentzer J; Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA., Wong GC; Division of Cardiology, Department of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada., Brunham LR; Centre for Heart Lung Innovation, The University of British Columbia, Vancouver, British Columbia, Canada., Senaratne J; Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada; The Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada., van Diepen S; Department of Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada; The Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada., Kaul P; The Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada; Division of Cardiology, Department of Medicine, University of Alberta, Edmonton, Alberta, Canada. Electronic address: pkaul@ualberta.ca.
Jazyk: angličtina
Zdroj: The Canadian journal of cardiology [Can J Cardiol] 2024 Nov; Vol. 40 (11), pp. 2079-2088. Date of Electronic Publication: 2024 Jul 09.
DOI: 10.1016/j.cjca.2024.07.001
Abstrakt: 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.
(Copyright © 2024 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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