Characteristics of Very Young Patients Who Experience a Myocardial Infarction: An Opportunity for Enhanced Prevention

Abstract

Aims: We sought to compare the risk factor profiles and outcomes between very young (age ≤40) and young (40< age ≤50) individuals who experienced a first-time MI at a young age. Methods: We evaluated all patients ≤ 50 years of age who were admitted with a type 1 MI to two 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 MI, a total of 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%) and less hypertension (37.9% vs. 50.9%). There was a higher proportion of spontaneous coronary artery dissection in very young patients (3.1% vs. 1.1% p=0.003). Upon discharge, very young MI patients were less likely to be prescribed a statin (85.9% vs. 89.9% p=0.017) and aspirin (92% vs. 95.2%, p=0.011). Over a median follow-up of 11.2 years, very young MI patients had a similar risk of all-cause and CV mortality. Conclusions: Despite being on average 10 years younger and having a lower prevalence of hypertension, very young MI patients had similar one-year and long-term outcomes when compared to those who were aged 41 to 50 at the time of their index infarction. Our findings suggest the need for aggressive secondary prevention measures in very young patients who experience an MI.