Junjie Yang1, David W Biery2, Avinainder Singh3, Sanjay Divakaran2, Ersilia M DeFilippis4, Wanda Y Wu2, Josh Klein5, Jon Hainer5, Mattheus Ramsis2, Pradeep Natarajan6, James L Januzzi6, Khurram Nasir3, Deepak L Bhatt2, Marcelo F Di Carli7, Ron Blankstein8. 1. Cardiovascular Division, Department of Medicine; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass; Department of Cardiology, Chinese PLA General Hospital, Beijing, China. 2. Cardiovascular Division, Department of Medicine. 3. Yale University School of Medicine, New Haven, Conn. 4. New York Presbyterian-Columbia University Irving Medical Center, New York, NY. 5. Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. 6. Cardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Mass. 7. Cardiovascular Division, Department of Medicine; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. 8. Cardiovascular Division, Department of Medicine; Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Mass. Electronic address: rblankstein@bwh.harvard.edu.
Abstract
BACKGROUND: Despite significant progress in primary prevention, the rate of myocardial infarction has not decreased in young adults. We sought to compare the risk factor profiles and outcomes between individuals who experienced a first myocardial infarction at a very young (≤40 years) and a young (age 41-50 years) age. METHODS: We evaluated all patients ≤50 years of age admitted with a Type 1 myocardial infarction to 2 large academic hospitals from 2000 to 2016. Risk factors were determined by review of electronic medical records. The primary outcomes of interest were all-cause and cardiovascular mortality. RESULTS: Among 2097 consecutive young patients with myocardial infarction, 431 (20.5%) were ≤40 years of age. When compared with their older counterparts, very young patients had similar risk profiles, with the exception of greater substance abuse (17.9% vs 9.3%, P < .001) and less hypertension (37.9% vs 50.9%, P < .001). Spontaneous coronary artery dissection was more prevalent in very young patients (3.1% vs 1.1%, P = .003). Over a median follow-up of 11.2 years, very young myocardial infarction patients had a similar risk of all-cause and cardiovascular mortality. CONCLUSIONS: Despite being, on average, 10 years younger and having a lower prevalence of hypertension, very young myocardial infarction patients had similar 1-year and long-term outcomes when compared with those aged 41 to 50 years at the time of their index infarction. Our findings suggest the need for aggressive secondary prevention measures in very young patients who experience a myocardial infarction.
BACKGROUND: Despite significant progress in primary prevention, the rate of myocardial infarction has not decreased in young adults. We sought to compare the risk factor profiles and outcomes between individuals who experienced a first myocardial infarction at a very young (≤40 years) and a young (age 41-50 years) age. METHODS: We evaluated all patients ≤50 years of age admitted with a Type 1 myocardial infarction to 2 large academic hospitals from 2000 to 2016. Risk factors were determined by review of electronic medical records. The primary outcomes of interest were all-cause and cardiovascular mortality. RESULTS: Among 2097 consecutive young patients with myocardial infarction, 431 (20.5%) were ≤40 years of age. When compared with their older counterparts, very young patients had similar risk profiles, with the exception of greater substance abuse (17.9% vs 9.3%, P < .001) and less hypertension (37.9% vs 50.9%, P < .001). Spontaneous coronary artery dissection was more prevalent in very young patients (3.1% vs 1.1%, P = .003). Over a median follow-up of 11.2 years, very young myocardial infarctionpatients had a similar risk of all-cause and cardiovascular mortality. CONCLUSIONS: Despite being, on average, 10 years younger and having a lower prevalence of hypertension, very young myocardial infarctionpatients had similar 1-year and long-term outcomes when compared with those aged 41 to 50 years at the time of their index infarction. Our findings suggest the need for aggressive secondary prevention measures in very young patients who experience a myocardial infarction.
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