ABSTRACT
Background:
According to the 2017 ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation, primary percutaneous coronary intervention (pPCI) is the recommended reperfusion strategy in patients with ST-Elevation Myocardial Infarction (STEMI) within 12 h of symptom onset and if time from STEMI diagnosis to PCI is ≤ 120 min.
Although the majority of STEMI occurs in older patients, non-negligent part concerns young patients (≤45 years old), and those patients seem to have an atypical risk factor profile, as well as a favourable prognostic.
This study aims to compare two age groups of patients who underwent pPCI for STEMI in terms of risk factors and prognostic.
Methods:
In this retrospective study, all patients that underwent pPCI for STEMI in CHUV, a Swiss tertiary university hospital, during a three-year period (in between January 2013 and December 2015) were retrospectively studied, without any exclusion criteria.
Patients were divided into two groups according to age at presentation of STEMI. The patients who were aged ≤ 45 years old were considered to be the young group, whereas the patients aged > 45 were considered to be the older group.
The two groups were compared in terms of risk factors and prognostic, using data acquired during the procedure and at 3- and 12-months follow-up.
Results:
A total of 753 patients were studied, dived into the young group (n= 63, 8.4%) and the older group (690 patients, 91.6%). Mean age was 63.89 ± 13.62 and 75.1% were men. Patients in the young group were more likely to be men than in the older group (95.2% vs 73.3%, p<0.001).
Young patients were more likely to be active smokers (78.9% vs 51.4%, p<0.001) and have a positive family history of cardiovascular disease (49.2% vs 31.1%, p=0.005), and were less likely to suffer from hypertension (17.7% vs 52.8%, p<0.001). No significant differences could be shown between age groups when it comes to diabetes (11.1% vs 19.0%, p=0.120) and dyslipidaemia (77.6% vs 72.2%, p=0.375).
Angiographic findings show a significant difference between the groups (p<0.001), with group 1 having more single-vessel lesions (63.5% vs 42.0%, p=0.001) and less 3-vessel lesions (11.1% vs 25.4%, p=0.011).
No significant difference could be found between age groups regarding hospital survival, hospital complications and at both three-month and 12-month follow-up in term of cardiovascular mortality, all-cause mortality, or complications.
A Kaplan-Meier estimate of global survival from PCI to 1-year show a difference between age groups (350.9 ± 9.8 vs 337.3 ± 3.8), although not statistically significant according to the the log-rank test (Chi-Square 1.843, df=1, p=0.175).
Conclusion:
In our study, young patient had a specific risk factor profile when opposed to their older peers. We couldn’t find any significant difference in term of prognostic during hospital stay, and at 3- and 12-month follow-up. In our study, active smoking is the only modifiable risk factor that is over-represented in young patients. Therefore, we conclude on the utmost importance, as a matter of public health, of targeting smoking, especially in young individuals, to have an impact on STEMI in this population.