Clinical characteristics and in-hospital prognostic factors in young patients with myocardial infarction.

OBJECTIVES

This study aims to analyze the clinical characteristics and short-term prognostic factors of young patients with acute myocardial infarction.

METHODS

This retrospective observational study included young patients (aged 18 to 45 years) who visited our center for AMI from January 1, 2014, to October 31, 2023. Baseline and outcome data were collected through the medical records system, with the primary endpoint being in-hospital major adverse cardiovascular events (MACE). Patients were divided into MACE and non-MACE groups based on the occurrence of in-hospital MACE. Coronary angiography was performed in 154/158 patients, all achieving post-procedural TIMI 3 flow. Multivariable logistic regression using Firth penalized likelihood with a priori-selected variables (LVEF, serum uric acid, age) was used to identify independent predictors of MACE.

RESULTS

Of 166 young patients initially screened, 158 were included in the final analysis after excluding 8 due to incomplete data. Among these, 27 (17.1%) experienced in-hospital MACE. Patients in the MACE group had a lower prevalence of diabetes (0.00% vs. 19.08%, P = 0.008), lower admission blood pressure and worse left ventricular dysfunction [lower left ventricular ejection fraction (LVEF), larger left ventricular end diastolic diameter (LVEDD)]. Single-vessel disease was the most common (38.96%), with 83.77% of patients having involvement of the left anterior descending artery. The proportion of left main disease was higher in the MACE group (15.38% vs. 3.91%, P = 0.045). In the Firth model, lower LVEF was the sole independent predictor of MACE (OR 0.859, 95% CI 0.794-0.917, P < 0.001), while serum uric acid and age were not significant.

CONCLUSION

The clinical characteristics and coronary artery lesion features of young AMI patients are unique. Reduced LVEF is the sole independent predictor of in-hospital MACE in our cohort, underscoring the value of ventricular function assessment for short-term risk stratification.