Long‐term prognosis of young patients after myocardial infarction in the thrombolytic era

• Published in: Clinical cardiology (Mahwah, N.J.) Vol. 20; no. 12; pp. 993 - 998
• Main Authors: Füllhaas, Jörg‐Uwe, Rickenbacher, Peter, Pfisterer, Matthias, Ritz, Rudolf
• Format: Journal Article
• Language: English
• Published: New York Wiley Periodicals, Inc 01.12.1997; Wiley
• Subjects: Adult; Aged; Angioplasty, Balloon, Coronary; Biological and medical sciences; Cardiology. Vascular system; Clinical Investigation; Clinical Investigationss; coronary angioplasty; Coronary Artery Bypass; Coronary heart disease; Female; Fibrinolytic Agents - therapeutic use; Follow-Up Studies; Heart; Hospital Mortality; Humans; Male; Medical sciences; Middle Aged; Morbidity; myocardial infarction; Myocardial Infarction - diagnosis; Myocardial Infarction - mortality; Myocardial Infarction - therapy; Myocardial Reperfusion - methods; Prognosis; Retrospective Studies; Survival Rate; Switzerland - epidemiology; thrombolysis; Thrombolytic Therapy; young age; Switzerland; Human; Prognosis; Infarct; Coronary artery; Instrumentation therapy; Cardiovascular disease; Instrumental dilatation; Coronary heart disease; Myocardial disease; Chemotherapy; Treatment; Follow up study; Young adult; Myocardium; Fibrinolytic
• ISSN: 0160-9289; 1932-8737
• DOI: 10.1002/clc.4960201204

Background: Myocardial infarction (MI) in young adults is a rare event. In the Framingham study, the 10‐year incidence rate of MI per 1,000 was 12.9 in men 30–34 years old. Overall, 4–8% of patients with acute MI are ≤ 40 years old. Hypothesis: It was the purpose of this study to assess the in‐hospital and long‐term morbidity and mortality in patients ≤40 years old with acute myocardial infarction compared with older patients in the thrombolytic era. Methods: A consecutive series of 75 patients aged ≤40 years (mean 35.0 ± 4.8) with acute myocardial infarction was compared with an equally sized group of patients aged >40 years (mean 65.1 ± 9.8). Results: Thrombolysis or direct percutaneous transluminal coronary angioplasty was performed in 52 versus 24% (p = 0.0004) and 5.3 versus 2.7% (p = NS) in younger and older patients, respectively. Significantly fewer young patients had multivessel disease (28 vs. 64%, p < 0.004). No in‐hospital mortality was observed in patients with reperfusion therapy irrespective of age. After a mean followup time of 47 ± 35 months, cardiac mortality was 0 and 11% (p < 0.03), respectively, in young and older patients with, and 3 versus 24% (p < 0.02) without reperfusion therapy, respectively. In addition, significantly fewer patients in the younger age group developed recurrent angina pectoris (12 vs. 39%, p = 0.0004) or congestive heart failure (9 vs. 34%, p = 0.0005) irrespective of reperfusion therapy. Conclusion: Our observations demonstrate that long‐term prognosis after myocardial infarction in young patients is excellent in the thrombolytic era.