SPC365

Premature myocardial infarction with ST elevation- 10 years of experience

Session: Posters (Sessão 3 - Écran 2) - Enfarte Agudo do Miocárdio 2
Speaker: Marta Catarina Bernardo

Congress: CPC 2023
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.7 Acute Coronary Syndromes - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Marta Catarina Bernardo; Isabel Martins Moreira; Catarina Ribeiro Carvalho; Pedro Rocha Carvalho; Sara Borges; Pedro Mateus; Sofia Silva Carvalho; Ilídio Moreira
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#212529">Introduction:&nbsp;</span></span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#333333">Myocardial infarction (MI) at young ages has increased in recent years and is a leading cause of premature death worldwide. </span></span><span style="background-color:white"><span style="color:#212529">The clinical course, risk factors, and coronary anatomy of MIs that develop at an early age differ from those at older ages. The paucity&nbsp;</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#212529">of studies and lack of guidelines for assessing and managing young MI patients (pts)&nbsp;make the clinical approach of these patients more challenging.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#212529">Purpose:&nbsp;</span></span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#212529">To characterize the population of pts with premature MI with ST elevation admitted to our centre between 2011 and 2021. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#212529">Methods:&nbsp;</span></span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#212529">We performed a retrospective analysis of pts admitted to our centre between 2011 and 2021 with the diagnosis of ST elevation MI in premature ages (&le; 55 years for women and &le;50 years for men). </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#212529">Results:&nbsp;</span></span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#212529">We included 169 pts, 130 males (76,5%), mean age of 44,3 (&plusmn; 5,2) years. Concerning cardiovascular risk factors, 65,3% were current smokers, 11,8% former smokers, 54,1% had dyslipidemia, 28,4% obesity, 27,6% hypertension, 15,9% had a family history of cardiovascular disease, 10,6% diabetes, and 1,8% were intravenous drug users. Regarding history of coronary artery disease, 4,1% of the pts had&nbsp;a past myocardial infarction.&nbsp;</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#212529">The most common clinical presentation was typical chest pain in 91,7% of patients. As </span></span><span style="background-color:white"><span style="color:#202124">associated symptoms, </span></span><span style="background-color:white"><span style="color:#212529">4,1% presented with dyspnoea, 34,9% with vagal symptoms, 1,8% with syncope and 10,1% with cardiac arrest. The troponin peak median was 4,6 ng/ml (IQR 2,3-8,9).&nbsp;</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#212529">The electrocardiogram showed inferior ST elevation at 49,1%, anterior at 44,4 % and lateral at 5,3% of the pts. The median &ldquo;symptom to wire crossing time&rdquo; was 5 hours (IQR 3,0-9,0). Regarding angiographic characteristics, the left anterior descending artery was the &ldquo;culprit&rdquo; in 50,3%, followed by the right coronary artery in 36,7% pts. 50,3% of the pts had multivessel disease and 42,9% had complete revascularization during the hospitalization. The mean ejection fraction pre-discharge was 50,1% (&plusmn;9,4) and 18,3% of pts had LVEF&lt;35%.&nbsp;</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#212529">The mean length of stay was 5,7 &plusmn; 3,5 days. During hospitalization, the majority of pts (85,6%) presented in Killip class I, 4 pts developed paroxysmal atrial fibrillation, 2,4% transitory ventricular arrhythmias and 3% acute kidney injury. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#212529">During a mean follow-up of 52,1 (&plusmn;34,5) months, 7,1% of the pts had a recurrence of myocardial infarction, 7,1% developed heart failure, with need for hospitalization in 2,4% and&nbsp;3,0% died of non-cardiovascular causes. </span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="background-color:white"><span style="color:#212529">Conclusions:&nbsp;</span></span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#212529">In our population, premature myocardial infarction was more prevalent in males. In most pts, the clinical presentation was typical, with a high proportion of pts presenting with cardiac arrest. Despite this, the overall clinical evolution was favorable. The frequency of modifiable risk factors, such as tobacco use, and dyslipidemia highlights the importance of primary prevention strategies</span></span></span></span></p>