Risk markers of complications of acute myocardial infarction in long-term follow-up depending on the age of patients

August 27, 2019

The aim is to identify risk markers for complications of acute myocardial infarction (AMI) in long-term follow-up, depending on the age of the patients. Object and research methods. The data of remote monitoring of patients hospitalized with a diagnosis of «Acute coronary syndrome with ST segment elevation» and undergoing treatment in the intensive care unit were analyzed. Depending on age, patients are divided into two groups: 1-st (n=160) — <45, 2-nd (n=457) — ≥45 years. The mean follow-up was 4.89±2.66 years. We evaluated the death rate from any causes within 5 years of observation, the development of a combined endpoint (CEP), cardiovascular death (CVD)/AMI/stroke over 5 and 10 years. Results. Patients of the 1st group had significantly better survival during 10 years of observation than the 2nd (Log-rank test — LRT; p=0.027). The difference in the curves was determined after the 1-st year of observation (LRT; p=0.031), as well as after 3; 5 and 10 years. CVD or repeated AMI was also more often observed in patients of the 2-nd group (LRT; p=0.021). Patients aged <35 years showed better survival rates among the studied subgroups; with increasing age, the frequency of complications increased. Arterial hypertension is the main risk factor for the development of long-term complications in young patients (relative risk 4.0; 95% confidence interval 1.5–10.7; p=0.006). Patients with a low left ventricular ejection fraction (LV EF) (<40%) on the 1-st day after AMI had a high probability of death from any causes within 5 years of follow-up (relative risk 3.4; 95% confidence interval 1.2–2.05; p=0.022). Patients who underwent myocardial revascularization during the first 3 years had significantly fewer ischemic complications (CVD/repeated AMI/stroke) (LRT; p=0.048). Findings. Patients of a young age (<45 years) with AMI are characterized by fewer complications during a long (<10 years) out-of-hospital observation period compared with the older age group. Among the risk factors for recurring cardiovascular events in these patients are concomitant arterial hypertension and LV dysfunction. However, reduced LVEF (<40%) upon admission was more important for the death within 5 years of observation, and maintaining values <50% on the 5–7-th day of the disease was important for the development of CEP. Myocardial revascularization (thrombolysis or primary percutaneous intervention) reduces the risk of developing CEP only during the first 3 years of observation, then its positive value is lost. The absence of hemodynamically significant stenosis of the coronary arteries according to coronary ventriculography, the age <35 years and the timely conduct of drug or mechanical myocardial revascularization indicate a low risk of complications during prolonged observation.

Published: 27.08.2019


  • Parkhomenko A.N., Amosova K.M., Dziak H.V. et al. (2013) Rekomendatsii Asotsiatsii kardiolohiv Ukrainy shchodo vedennia patsiientiv z hostrym koronarnym syndromom z elevatsiieiu sehmenta ST. Ukr. kardyol. zhurn., dodatok 3.
  • Aggarwal A., Aggarwal S., Goel A. et al. (2012) A retrospective case-control study of modifiable risk factors and cutaneous markers in Indian patients with young coronary artery disease. JRSM Cardiovasc. Dis., 1(3): cvd.2012.012010.
  • Barbash G.I., White H.D., Modan M. et al. (1995) Acute myocardial infarction in the young – the role of smoking. The Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Trial. Eur. Heart J., 16(3): 313–316.
  • Bonaca M.P., Storey R.F., Theroux P. et al. (2017) Efficacy and safety of ticagrelor over time in patients with prior MI in PEGASUS-TIMI 54. J. Am. Coll. Cardiol., 70(11): 1368–1375.
  • Chaudhary P., Agarwal N., Kulshrestha M. et al. (2016) Assesment of myocardial infarction in young patients. Int. J. Contemp. Med. Res., 3(12): 3467–3470.
  • Chung S.C., Gedeborg R., Nicholas O. et al. (2014) Acute myocardial infarction: a comparison of short-term survival in national outcome registries in Sweden and the UK. Lancet, 383: 1305–1312.
  • Cole J.H., Miller J.I.3rd, Sperling L.S., Weintraub W.S. (2003) Long-term follow-up of coronary artery disease presenting in young adults. J. Am. Coll. Сardiol., 41(4): 521–528.
  • Eikelboom J.W., Connolly S.J., Bosch J. et al. (2017) Rivaroxaban with or without aspirin in stable cardiovascular disease. N. Engl. J. Med., 377: 1319–1330.
  • Eisen A., Giugliano R.P., Braunwald E. (2016) Updates on acute coronary syndrome: a review. JAMA Cardiol., 1: 718–730.
  • Fournier J.A., Cabezon S., Cayuela A. et al. (2004) Long-term prognosis of patients having acute myocardial infarction when ≤40 years of age. Am. J. Cardiol., 94: 989–992.
  • Ghosh K., Khare A., Shetty S. (2007) Fasting plasma homocysteine levels are increased in young patients with acute myocardial infarction from Western India. Ind. Heart J., 59: 242–245.
  • Gupta A., Wang Y., Spertus J.A. et al. (2014) Trends in acute myocardial infarction in young patients and differences by sex and race, 2001 to 2010. J. Am. Coll. Cardiol., 64: 337–345.
  • Haller P.M., Jäger B., Farhan S. et al. (2017) Impact of age on short- and long-term mortality of patients with ST-elevation myocardial infarction in the VIENNA STEMI network. Wiener Klinische Wochenschrift, 130(5–6): 172–181.
  • Imazio M., Bobbio M., Bergerone S. et al. (1998) Clinical and epidemiological characteristics of juvenile myocardial infarction in Italy: The GISSI experience. G. Ital. Cardiol., 28: 505–512.
  • Jacquemin L., Bourrelly N., Roth O. et al. (2010) Acute myocardial infarction in young smokers treated by coronary angioplasty. In-hospital prognosis and long-term outcome in a consecutive series of 93 patients. Ann. Cardiol. d’Angéio., 59: 119–124.
  • Konishi H., Miyauchi K., Kasai T. et al. (2014) Long-term prognosis and clinical characteristics of young adults (≤40 years old) who underwent percutaneous coronary intervention. J. Cardiol., 64(3): 171–174.
  • Mandelzweig L., Battler A., Boyko V. et al. (2006) The second Euro Heart Survey on acute coronary syndromes: сharacteristics, treatment and outcome of patients with ACS in Europe and the Mediterranean basin in 2004. Eur. Heart J., 27(19): 2285–2293.
  • McManus D.D., Piacentine S.M., Lessard D. et al. (2011) Thirty-year (1975 to 2005) trends in the incidence rates, clinical features, treatment practices, and short-term outcomes of patients <55 years of age hospitalized with an initial acute myocardial infarction. Am. J. Cardiol., 108: 477–482.
  • Meliga E., DeBenedictis M., Gagnor A. et al. (2012) Conte Long-term outcomes of percutaneous coronary interventions with stent implantation in patients ≤40 years old. Am. J. Cardiol., 109(2012): 1717–1721.
  • Rathod K.S., Jones D.A., Gallagher S. et al. (2016) Atypical risk factor profile and excellent long-term outcomes of young patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction. Eur. Heart J. Acute Cardiovasc. Care, 5(1): 23–32.
  • Risgaard B., Nielsen J.B., Jabbari R. et al. (2013) Prior myocardial infarction in the young: predisposes to a high relative risk but low absolute risk of a sudden cardiac death. Europace, 15: 48–54.
  • Steg P.G., James S.K., Atar D. et al. (2012) Task Force on the management of ST-segment Elevation Acute Myocardial Infarction of the European Society of Cardiology. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur. Heart J., 33: 2569–2619.
  • Wiesbauer F., Blessberger H., Azar D. et al. (2009) Familial-combined hyperlipidaemia in very young myocardial infarction survivors (<or=40 years of age). Eur. Heart J., 30: 1073–1079.
  • Yusuf S., Hawken S., Ounpuu S. et al. (2004) Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet, 364: 937–952.
  • Zimmerman F.H., Cameron A., Fisher L.D., Ng G. (1995) Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis (Coronary Artery Surgery Study Registry). J. Am. Coll. Cardiol., 26: 654–661.