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. 2022 Jul 5;2(5):574-585.
doi: 10.1016/j.jacasi.2022.03.013. eCollection 2022 Oct.

Clinical Presentation and In-Hospital Outcomes of Acute Myocardial Infarction in Young Patients: Japanese Nationwide Registry

Hirohiko Ando  1 , Kyohei Yamaji  2 , Shun Kohsaka  3 , Hideki Ishii  4 , Kenichi Sakakura  5 , Reiji Goto  1 , Yusuke Nakano  1 , Hiroaki Takashima  1 , Yuji Ikari  6 , Tetsuya Amano  1
Affiliations

Clinical Presentation and In-Hospital Outcomes of Acute Myocardial Infarction in Young Patients: Japanese Nationwide Registry

Hirohiko Ando et al. JACC Asia. .

Abstract

Background: Acute myocardial infarction (AMI) in young patients is a concerning issue because of its adverse health and social impacts. Nevertheless, risk factors and prognosis of AMI in young patients are yet to be characterized.

Objectives: This study aimed to characterize AMI in young patients who underwent primary percutaneous coronary intervention (PCI) using large-scale nationwide all-comer registry data in Japan, the Japanese Percutaneous Coronary Intervention (J-PCI).

Methods: This retrospective cohort study evaluated the J-PCI registry data of patients with AMI aged 20 to 79 years who underwent primary PCI between January 2014 and December 2018. Data on risk factor profiles, clinical features, post-procedural complications, and in-hospital outcomes were reviewed.

Results: Among 213,297 patients with AMI who underwent primary PCI, 23,985 (11.2%) were young (ages 20 to 49 years). Compared with the older group (ages 50 to 79 years; n = 189,312), the younger group included a higher number of men, smokers, patients with dyslipidemia, and patients with single-vessel disease, and a lower number of patients with hypertension and diabetes. Despite favorable clinical profiles, younger age was associated with a higher rate of presentation with cardiopulmonary arrest (CPA). Further, concomitant CPA was strongly associated with in-hospital mortality in young patients (odds ratio: 14.2; 95% CI: 9.2 - 21.9).

Conclusions: Younger patients with AMI presented a higher risk of CPA, which was strongly associated with in-hospital mortality. The results of this study highlight the importance of primary AMI prevention strategies in young individuals.

Keywords: AMI, acute myocardial infarction; CKD, chronic kidney disease; CPA, cardiopulmonary arrest; LMT, left main trunk; MI, myocardial infarction; PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction; acute myocardial infarction; cardiopulmonary arrest; in-hospital mortality; risk factor; young patients.

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Conflict of interest statement

Dr Ando has received Japan Society for the Promotion of Science KAKENHI grant number JP80632885; and lecture fees from Daiichi Sankyo, Bristol-Myers Squibb, Kowa Co, Ltd, and Boehringer Ingelheim. Dr Kohsaka has received investigator-initiated grant funding from Bayer and Daiichi Sankyo; and personal consulting fees from Bayer and Bristol-Myers Squibb. Dr Ishii has received lecture fees from Astellas Pharma, AstraZeneca, Bayer, Bristol-Myers Squibb, Chugai Pharmaceutical, Daiichi-Sankyo, and MerckSharpe and Dohme, and Kabushiki-Kaisha. Dr Nakano has received lecture fees from Otsuka Pharm Co, Ltd, Bristol-Myers Squibb, and Kowa Co, Ltd. Dr Amano has received lecture fees from Astellas Pharma, AstraZeneca, Bayer, Daiichi Sankyo, and Bristol-Myers Squibb. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Patient Inclusion Flow Chart From the Japanese Percutaneous Coronary Intervention (J-PCI) registry, a total of 277,015 patients with acute myocardial infarction (AMI) were evaluated. After excluding the data from 63,718 patients with missing information on age or sex and those aged ≤19 and ≥80 years, the data from 213,297 patients were included in the analysis. Among them, 23,985 (11.2%) and 189,312 patients (88.8%) were further classified into the younger and older groups, respectively. MI = myocardial infarction, PCI = percutaneous coronary intervention.
Figure 2
Figure 2
Prevalence of Risk Factors According to Age Group The prevalence of risk factor profiles between the younger and older groups is presented. Concerning the overall trend, the younger age groups included a higher number of male patients and had a lower prevalence of traditional coronary risk factors, such as hypertension, diabetes, and chronic kidney disease (CKD), but a high prevalence of smoking and dyslipidemia.
Central Illustration
Central Illustration
Characteristics and Adjusted Odds Ratios for Adverse Events Clinical characteristics in young patients with acute myocardial infarction (AMI) and adjusted odds ratios for cardiopulmonary arrest, in-hospital mortality, and bleeding complications are presented. Despite favorable clinical profiles, younger age was associated with a higher rate of presentation with cardiopulmonary arrest. The incidences of in-hospital death and bleeding complications were lower in younger patients. N/A = not applicable.
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