Salik Ur Rehman Iqbal1
1Aga Khan University Hospital, Karachi, Pakistan
As South Asians have more complex coronary lesions and present at an earlier age with their first MI, prognosis in young patients might be different from the elder ones. The objective in this study was to compare mortality outcomes between young (<45 years) STEMI patients and Elder (>45 years) STEMI patients.
It was a retrospective cohort study done from 2013-2018 on STEMI patients aged between 18-65 years who underwent immediate Coronary Catheterization and Percutaneous Intervention. Patients with poor prognostic conditions like previous MI, known LV Dysfunction, Prior revascularization, dialysis dependant and stroke patients were excluded. As these conditions are more prevalent in elder ages, such high risk patients were automatically excluded from the elder age group. Patients were followed for Mortality for a total of 30 days post STEMI.
Of 361 patients, 151 were <45 years of age (mean: 39.4 vs.59.9 years). They were predominantly men (90.0% vs. 72.0%, p<0.05), obese (51.0 % vs. 36.0%, p=0.01) and had Single vessel disease (67% vs. 45%, p<0.05) but had a lower prevalence of hypertension (31.0 % vs. 57.0%, p<0.05). Double and triple vessel disease was more common in after age 45, (23% vs. 36%, p<0.05) and (8% vs. 18%, p<0.05) respectively. Difference in Diabetes (37% vs. 46.3%), Positive family history of Premature Coronary Artery Disease (47.2% vs. 53.6%) and Smoking status (45% vs. 36.4%) were non-significant. The relative risk for All-Cause-Mortality at 30 days post STEMI was found to be 1.4 (0.5-3.6) which was non-significant which did not change even after adjustment for potential confounders like obesity, diabetes, Positive family history of CAD, Smoking, etc.
Short term Mortality in Young STEMI patients may be comparable to elder patients if patients with poor prognostic conditions are excluded.