Clinical characteristics and outcomes of young patients with acute myocardial infarction: YAMI registry

Introduction Despite its low prevalence, premature myocardial infarction (MI) bears serious social consequences and shares different pathophysiology. Objectives The aim of the study was to evaluate young MI patients in terms of clinical characteristics and long-term outcomes. Patients and methods This study is an observational research covering 221 patients <45 years old [16.7% women, age 38.4(4.8) years], hospitalized due to acute MI between January 2017 and April 2023. Data was extracted from Academic Repository of Clinical Cases of Medical University of Silesia. Young MI patients were compared to representative MI cohort >45 years old (n=2256). The mean follow-up time was 648.7(178.7) days. The primary end-point was all-cause mortality. Results Patients with MI <= 45 years were predominantly male (83.3%), had lower mortality (7.2%vs.15.0%,log-rank P=0.01), shorter hospitalization time [4.0(3.0; 6.0)vs. 5.0(3.0; 6.0) days, P=0.03] and less pronounced cardiovascular risk factors than patients >45 years old. Cox regression in MI patients <= 45 years indicated that peri-MI sudden cardiac arrest, Q waves presence, higher volume of contrast and lack of qualification to cardiac rehabilitation (CR) were independent predictors of mortality. In young cohort, 15.8% of patients had MI unrelated to ruptured atheroma and more often had non-ST-elevation acute MI, were female and younger, had lower prevalence of hyperlipidemia and hypertension, less often were referred for PCI and CR, and more often for optical coherence tomography and cardiac magnetic resonance (CMR). Conclusions Young MI patients have favorable prognosis and frequently have atypical MI pathophysiology. Cardiac rehabilitation is of utmost importance in mortality reduction regardless of age.