DEMOGRAPHIC, CLINICAL AND ANGIOGRAPHIC PROFILE OF YOUNG ADULTS (<= 45 YEARS) UNDERGOING PERCUTANEOUS CORONARY INTERVENTION FOR ST ELEVATION MYOCARDIAL INFARCTION

IntroductionPremature (defined as ≤45 years old at presentation) ST Elevation Myocardial Infarction (STEMI) remains a significant population health issue despite overall reductions in age adjusted incidence of acute myocardial infarction (AMI). Premature STEMI may be associated with a different risk profile to AMI presenting at a later age, and/or a different pattern of clinical presentation; and consequently may benefit from an age tailored secondary preventative strategy.MethodsRetrospective chart review of all patients who underwent angiography in a single primary percutaneous coronary intervention (PCI) centre over a 68 month period for suspected STEMI. Patients were stratified as young (≤45 years) or older (>45 years). Documented risk factors, procedural metrics and clinical outcomes were recorded and compared between the two groups [table 1].ResultsOf the 2045 consecutive patients presenting with STEMI, 193 (9.44%) were young. While 1601 (78%) of all presentations were male, a significantly greater proportion of younger patients were male (165/193; 85%; p<0.005). Younger patients had significantly fewer diagnosed comorbidities such as angina (4.2% vs 13.9%; p<0.005), prior PCI (5.4% vs 10.2%; p=0.006), dyslipidaemia (35.6% vs 53.8%; p<0.005) or hypertension (47.6 vs 26.5%; p<0.005), however were more likely to be current smokers (68.9% vs 45.1%; p<0.005). Younger patients were more likely to present in stable condition (90.8% vs 86%; p=0.048), and less likely to be in cardiogenic shock (1.1% v s3.2%; p<0.005). Radial access was more common in younger patients (95.3% vs 90.3%; p=0.022). Following initial angiography, a significantly greater proportion of younger patients did not require PCI (24.5% vs 10.9%; p<0.005), with a higher proportion of subsequent ‘non-cardiac chest pain’ diagnoses being made in the younger group (3.8% vs 1.9%; p=0.022). However there was no significant difference in combined rates of (peri-)myocarditis or Tokosubo cardiomyopathy (4.1% vs 3.8%; p=0.72). Length of stay was not significantly different between the groups (4.36 vs 4.27 mean days; p=0.863). Younger patients had a lower 30-day mortality rate (2.7% vs 5%; p=0.049). Of the 148 patients ≤45 years who had obstructive coronaries at angiography, 14 (9%) had abnormal HbA1c results without a diagnosis of diabetes mellitus (DM), 5 of which were diagnostic at presentation. 67 (45%) had undiagnosed dyslipidaemia. Of the 63 younger patients who had echocardiograms prior to discharge, 37 (48%) had evidence of left ventricular dysfunction.ConclusionThe gender imbalance observed in STEMI presentations was exaggerated in younger patients. Our study correlates with previous literature suggesting that smoking carries a greater attributable risk for AMI in patients ≤45 years and reinforces the importance of smoking cessation in young males. These patients have high rates of undiagnosed DM and dyslipidaemia. The high rate of LVD is likely to have a significant impact on health outcomes in this young population.