Long-term outcomes of premature acute myocardial infarction: impact of multivessel disease.

Background Premature myocardial infarction (MI) is underrepresented in clinical trials, limiting understanding of its clinical characteristics and long-term prognosis. Purpose This study aimed to assess the distinct clinical features and long-term ischemic outcomes of patients with premature MI compared to non-premature MI. Methods We retrospectively analyzed the COREA-AMI registry, including MI patients who underwent percutaneous coronary intervention between 2001 and 2015. Premature MI was defined as age ≤ 45 years at presentation. The primary outcome was major adverse cardiac and cerebrovascular events (MACCE) and its components. Predictors of ischemic outcomes in premature MI were identified through Cox regression models, and clinical outcomes were compared between premature and non-premature MI. Fine-Gray subdistribution hazard regression and Cox regression with multiple imputation were performed as sensitivity analyses. Results Among 10,144 patients, 907 (8.9%) had premature MI. These patients had fewer comorbidities but higher LDL-C levels (≥160 mg/dL: 18.7% vs. 10.2%, P <.001) and lower rates of multivessel disease (34.3% vs. 55.3%, P <.001). In premature MI, chronic kidney disease and multivessel disease were independent predictors of MACCE, as well as recurrent MI and repeated revascularization. After adjustment, premature MI was associated with a higher risk of recurrent MI (HR 1.43, 95% CI 1.04–1.95, P =.026) but similar revascularization risk (HR 1.18, 95% CI 0.97–1.42, P =.101). Multivessel disease had a stronger impact on recurrent MI (P interaction =.002) and revascularization (P interaction =.020) in premature MI. Conclusions Premature MI patients had distinct clinical features and a higher risk of recurrent MI and but comparable revascularization risk. Multivessel disease was an important prognostic factor for ischemic outcomes in this population, warranting further investigations.KM curves stratified by age groups KM curves stratified by MVD and age

Total revascularization of coronary disease at the time of primary percutaneous coronary intervention.

Randomized trials have largely demonstrated that percutaneous coronary intervention (PCI) with sirolimus-eluting (SES) and paclitaxel-eluting stents (PES) results in a significant reduction in the occurrence of angiographic restenosis and revascularization compared with bare metal stents (BMS).1–4 The benefit of drug-eluting stents (DES) also has been confirmed in “real-world” scenarios. In this setting, when the analysis was focused on high-risk patient and lesion subgroups, a benefit still existed despite the presence of restenosis.5–7 These expanded indications do not yet cover many other types of complex lesions for which only registries or randomized trials, not yet published, are available so far (Tables 1 through 7⇓⇓⇓⇓⇓⇓). This topic is discussed in detail in this review. An important clarification is that the lack of proof is most probably due to the difficulty in performing randomized trials in high-risk groups using BMS as controls. It will be no surprise to find that the field in which DES perform best compared with BMS is likely to be complex lesions and patients8 (Figure 1). View this table: TABLE 1. DES in Unprotected Left Main Stenosis View this table: TABLE 2. DES in Bifurcation Lesions View this table: TABLE 3. DES in Chronic Total Occlusions View this table: TABLE 4. DES in Small-Vessel Disease and Long Lesions View this table: TABLE 5. DES in SVGs View this table: TABLE 6. DES in Acute MI View this table: TABLE 7. DES in Multivessel Disease Figure 1. Lesion complexity and stent performance in the BMS and DES eras. Adapted from Edelman et al.8 Current American Heart Association/American College of Cardiology (AHA/ACC) and European Society of Cardiology (ESC) guidelines consider the presence of a stenosis in the unprotected left main coronary artery (LMCA) a class IIa or IIb indication, respectively, for PCI if coronary artery bypass grafting (CABG) is not a viable option.9,10 Moreover, according to the AHA/ACC 2005 guidelines, in …

Objective: Hyperlipidemia is closely related to premature acute myocardial infarction (AMI). The present study was performed to explore the correlation between various blood lipid components and the risk of premature AMI. Methods: This is a cross-sectional retrospective study. Consecutive patients with acute ST-segment elevation myocardial infarction (STEMI), who completed coronary angiography from October 1, 2020 to September 30, 2022 in our hospital, were enrolled and divided into premature AMI group (male<55 years old, female<65 years old) and late-onset AMI group. Total cholesterol (TC), triglyceride (TG), low density lipoprotein cholesterol (LDL-C), high density lipoprotein cholesterol (HDL-C), non-HDL-C, lipoprotein (a) (Lp (a)), apolipoprotein B (ApoB), apolipoprotein A-1 (ApoA-1), non-HDL-C/HDL-C and ApoB/ApoA-1 were analyzed. The correlation between the above blood lipid indexes and premature AMI was analyzed and compared by logistic regression, restricted cubic spline and receiver operating characteristic curve (ROC). Results: A total of 1 626 patients with STEMI were enrolled in this study, including 409 patients with premature AMI and 1 217 patients with late-onset AMI. Logistic regression analysis showed that the risk of premature AMI increased significantly with the increase of TG, non-HDL-C/HDL-C, non-HDL-C, ApoB/ApoA-1, TC and ApoB quintiles; while LDL-C, ApoA-1 and Lp (a) had no significant correlation with premature AMI. The restricted cubic spline graph showed that except Lp (a), LDL-C, ApoA-1 and ApoB/ApoA-1, other blood lipid indicators were significantly correlated with premature AMI. The ROC curve showed that TG and non-HDL-C/HDL-C had better predictive value for premature AMI. Inconsistency analysis found that the incidence and risk of premature AMI were the highest in patients with high TG and high non-HDL-C/HDL-C. Conclusion: TG, non-HDL-C/HDL-C and other blood lipid indexes are significantly increased in patients with premature AMI, among which TG is the parameter, most closely related to premature AMI, and future studies are needed to explore the impact of controlling TG on incidence of premature AMI.

We sought to investigate the impact of multivessel coronary artery disease (CAD) on reperfusion success and prognosis following primary percutaneous coronary intervention (PCI) in patients with acute myocardial infarction (AMI). The influence of multivessel disease on myocardial reperfusion and subsequent survival after primary PCI has not been studied. In the CADILLAC trial, primary PCI was performed in 2082 patients of any age with AMI within 12 h of symptom onset. Myocardial perfusion post-PCI assessed by ST-segment recovery and myocardial blush and clinical outcomes were stratified by the extent of CAD. Single-, double-, and triple-vessel disease were present in 1066 (51.2%), 692 (33.2%), and 324 (15.6%) patients, respectively. Patients with multivessel disease compared with those with single-vessel disease undergoing primary PCI were significantly more likely to have absent ST-segment recovery (13.3 vs. 7.4%, P = 0.01), though the rates of post-procedural TIMI-3 flow (89.7 vs. 88.9%, P = 0.66) and grade 2 or 3 myocardial blush (51.2 vs. 51.5%, P = 0.91) in the infarct vessel were comparable. By 1 year, the cumulative incidence of death for patients with single-, double-, and triple-vessel disease was 3.2, 4.4, and 7.8%, respectively (P = 0.003), and the composite rate of major adverse cardiac events (MACE) was 14.8, 19.5, and 23.6%, respectively (P = 0.0006). By multivariable analysis, the presence of triple-vessel disease was the strongest predictor of 1-year death [hazard ratio (HR) = 2.60, P = 0.009], death and re-infarction (HR = 1.88, P = 0.03), and MACE (HR = 1.80, P = 0.0009). Patients with extensive CAD in vessels remote from the infarct-related artery have reduced reperfusion success and an adverse prognosis following primary PCI in AMI. Future studies regarding the optimal treatment of patients with multivessel disease and AMI are warranted.

Complete revascularization in STEMI and multivessel coronary artery disease: In search of the best strategy

This study sought to quantify the healthcare costs of multivessel disease (MVD) and determine the prevalence and incidence of recurrent major adverse cardiovascular events (MACE) in high-risk patients diagnosed with MVD following an acute myocardial infarction (MI). This retrospective study utilized German claims data (AOK PLUS), between 01/01/2010 and 31/12/2020. Patients were included if they (1) had an inpatient diagnosis of an MI between 01/01/2012 and 31/12/2019 (index date), (2) were ≥ 18 years of age at date of MI diagnosis, and (3) had diabetes or met two of the following criteria: ≥ 65 years old, prior MI, peripheral arterial disease. MACE was defined as (1) MI, (2) stroke, or (3) death with a cardiovascular diagnosis within 30 days prior. To measure the burden of MVD, patients were identified during the index hospitalization by presence of MVD. Healthcare resource use and costs were compared after adjustment based on propensity score matching (PSM). A total of 5158 patients with evidence for MVD were included in the main analysis. 31.17% experienced a MACE within 365 days following the incident MI. After PSM adjustment, 33.22% of the MVD cohort experienced a MACE versus 36.48% of non-MVD patients. MVD patients had a higher rate of recurrent MI (14.22% vs. 9.81%). Additionally, public healthcare costs were about €4 million higher in the total MVD cohort than in the non-MVD cohort in the first year after an MI (€47,896,012.32 vs. €43,718,713.75, respectively), reflecting the MVD cohort's higher use of the public healthcare system. More MVD patients were prescribed guideline-recommended medication (61.4% vs. 46.0%). This study found that presence of MVD contributed to higher rates of recurrent MI. Patients with MVD experienced higher rates of recurrent MI despite a higher proportion of patients receiving guideline-directed medication therapy compared to non-MVD patients. Conversely, there was a higher mortality rate observed in the non-MVD cohort.

Objective: To explore the related factors of premature acute myocardial infarction(AMI), and to compare the the long-term outcomes in patients with and without premature AMI after percutaneous coronary intervention (PCI). Methods: This study was a prospective cohort study.From January 2013 to December 2013, 10 724 consecutive patients with coronary heart disease undergoing PCI in Fuwai Hospital were enrolled. Among them 1 920 patients with the diagnosis of AMI were divided into two groups: premature AMI (man≤50 years old, woman≤60 years old) and non-premature AMI. The baseline characteristics were collected, and multivariate logistic regression was uesed to analysis the related factors of premature AMI. The clinical outcomes, including the major adverse cardiovascular and cerebrovascular events(MACCE) which was the composite of cardiac death, myocardial infarction, revascularization, stroke and stent thrombosis, as well as bleeding events, during hospitalization, at 2 years and 5 years follow-up were analyzed. Results: A total of 1 920 AMI patiens were included(age was (56.5±11.3) years old)，with 1 612(84.0%) males. There were statistically significant differences between the two groups in gender, body mass index, blood lipid, complications, inflammatory markers, etc (all P<0.05). Multivariate logistic regression analysis showed body mass index(OR=1.06, 95%CI 1.01-1.10, P<0.01), triglyceride(OR=1.47, 95%CI 1.14-1.90, P<0.01), serum uric acid level(OR=1.02, 95%CI 1.01-1.04, P<0.01), high density lipoprotein cholesterol level(OR=0.33, 95%CI 0.14-0.78, P=0.01) and history of hypertension(OR=0.72, 95%CI 0.56-0.93, P=0.01) were independent related factors of premature AMI. The incidence of all-cause death and cardiac death were lower during hospitalization, at 2 years and 5 years follow-up in the premature AMI group than in non-premature AMI group(all P<0.05). In the premature AMI group, the incidence of MACCE and stroke was lower, with more bleeding events in 5 years follow-up(all P<0.05). Conclusions: Metabolic abnormalities, including high BMI, high triglyceride level and high serum uric acid, low high-density lipoprotein cholesterol level are the related factor of premature AMI. The incidence of ischemic events in patients with premature AMI is lower, while the incidence of bleeding events is higher than non-premature AMI patients.

Influence of Second- and Third-Degree Heart Block on 30-Day Outcome Following Acute Myocardial Infarction in the Drug-Eluting Stent Era

Background Premature myocardial infarction (MI) is a poorly define clinical entity that represents a significant proportion of coronary artery disease (CAD) burden and warrants further exploration. Methods We conducted a comprehensive analysis of the FRENCHIE cohort, a prospective, multicenter observational study including 11,233 patients admitted for a first acute MI across 32 French hospitals. Patients were categorized into three age groups: &amp;lt;45 years, 45–55 years and &amp;gt;55 years. We assessed traditional and nontraditional cardiovascular risk factors, lipid profiles (LDL, HDL, triglycerides (TG), and remnant cholesterol), genetic predisposition inferred from family history of CAD, and behavioral risk factors (smoking, drug use, and social deprivation). Clinical presentation, in-hospital management, and outcomes (MACE) were analyzed. Results Among 11,233 patients, premature MI (&amp;lt;55 years) occurred in 3,672 (32.7%) patients, with 944 (8.4%) &amp;lt;45 years and 2,728 (24.3%) between 45–55 years, and 7,561 (67.3%) were &amp;gt;55 years. Younger MI patients had a higher prevalence of familial history of CAD (36.2% vs. 30.6% vs. 20.9%), higher average levels of LDL-C(140 mg/dL vs. 137 mg/dL vs. 126 mg/dL) with higher rate of patients &amp;gt;190mg/dl (12.6% vs. 9.1% vs. 6.0% ), TG (172 mg/dL vs. 171 mg/dL vs. 135 mg/dL), remnant cholesterol (31 mg/dL vs. 31 mg/dL vs. 26 mg/dL) and lower HDL-C (41 mg/dL vs. 43 mg/dL vs. 48 mg/dL), all p&amp;lt;0.0001. Behavioral risk factors such as active smoking (73.4% vs. 62.4% vs. 26.7%) and cannabis use (17.3% vs. 5.0% vs. 0.7%) were significantly more prevalent in younger patients. Social deprivation indicators, characterized by unemployment (12.8% vs. 9.4% 3.0%) or invalidity (4.2% vs. 4.5% vs 2.5%), were also more common in younger individuals; p&amp;lt;0.0001. Premature MI patients (&amp;lt;55 years old) had a lower risk of in-hospital MACE as compared to older patients (2.75% vs 4.3%, p&amp;lt;0.0001). The risks factors in premature acute MI patients as a first atherosclerotic events in the FRENCHIE Cohort as summarized in the figure. Conclusions Premature MI is associated with a distinct phenotype combining genetic predisposition, lipid abnormalities and frequent exposomic risk factors. Early lipid profiling, subclinical atherosclerosis screening and treatment strategies, alongside aggressive behavioral modification interventions, could play a crucial role in the prevention of premature CAD and need to be evaluated.

Background Disruption of endogenous circadian rhythms increases the risk of myocardial infarction. A few studies have confirmed that polymorphisms in the circadian rhythm gene PER2 are closely related to the onset of acute myocardial infarction (AMI), but there are few reports on its correlation with the prognosis of AMI patients. Purpose This study explores the impact of the single nucleotide polymorphism site rs934945 of the PER2 gene on the occurrence of major adverse cardiovascular events (MACE) in patients with premature acute myocardial infarction (PMI) in the long term. Methods A total of 640 patients with PMI who underwent emergency percutaneous coronary intervention (PPCI) from January 2017 to August 2022 were consecutively included. Male were ≤ 50 years and female were ≤ 55 years . The PER2 rs934945 gene polymorphism was analyzed by MassARRAY nucleic acid mass spectrometry analysis system. The onset time was divided into four time periods (00:00-05:59, 06:00-11:59, 12:00-17:59, 18:00-23:59). Follow-up time was 5 years, and MACE events were recorded. COX regression analysis was used to analyze association between gene polymorphism and MACE , as well as multivariate subgroup analysis and interaction. Results 353 have CC genotype, 234 have CT genotype, and 53 have TT genotype. The frequencies of C allele (wild type) and T allele (mutant type) were 0.734 and 0.266 respectively, which were different from those in other regions. Patients with CT + TT genotype who developed disease was higher than with CC genotype during 00:00-05:59 period (25.80% vs 17.80%), and the difference was statistically significant (Z =5.927, P &amp;lt; 0.05). The levels of Lp(a) and hs-CRP in CT + TT group were higher than in CC group (P &amp;lt; 0.05). Compared with CC genotype, overall risk of MACE in PMI patients with CT + TT genotype increased by 119% (HR 2.19, 95% CI: 1.73, 15.16, P = 0.01), and risk ratio was the highest in subgroup with high-sensitivity troponin T &amp;gt; 2.93, which was 5.34 (95% CI 1.67, 17.10, P = 0.005). In the interaction analysis, there was no interaction between genotype and onset time for MACE, with risk ratio of 0.985 (95% CI: 0.92, 1.05, P &amp;gt; 0.05). There was an interaction between genotype and high-sensitivity troponin T for MACE. Compared with CC genotype and high-sensitivity troponin T ≤ 2.93, the risk of MACE in patients with CT + TT genotype and high-sensitivity troponin T &amp;gt; 2.93 increased significantly to 6.38 times (95% CI: 2.14, 18.96, P &amp;lt; 0.05). Conclusion PMI onset in the 00:00-05:59 period was high in the PER2 rs934945 CT+TT genotype group. The genotype was correlated with risk prediction of long-term MACE , and the interaction with high-sensitivity troponin T significantly increased risk of MACE.

To investigate the risk factors, clinical features, and prognostic factors of patients with premature acute myocardial infarction (AMI). A retrospective cohort study of patients with AMI included in data from the West China Hospital of Sichuan University from 2011 to 2019 was divided into premature AMI (aged < 55 years in men and < 65 years in women) and non-premature AMI. Patients' demographics, laboratory tests, Electrocardiography (ECG), cardiac ultrasound, and coronary angiography reports were collected. All-cause death after incident premature MI was enumerated as the primary endpoint. Among all 8,942 AMI cases, 2,513 were premature AMI (79.8% men). Compared to the non-premature AMI group, risk factors such as smoking, dyslipidemia, overweight, obesity, and a family history of coronary heart disease (CHD) were more prevalent in the premature AMI group. The cumulative survival rate of patients in the premature AMI group was significantly better than the non-premature AMI group during a mean follow-up of 4.6 years (HR = 0.27, 95% CI 0.22-0.32, p < 0.001). Low left ventricular ejection fraction (LVEF) (Adjusted HR 3.00, 95% CI 1.85-4.88, P < 0.001), peak N-terminal pro-B-type natriuretic peptide (NT-proBNP) level (Adjusted HR 1.34, 95% CI 1.18-1.52, P < 0.001) and the occurrence of in-hospital major adverse cardiovascular and cerebrovascular events (MACCEs) (Adjusted HR 2.36, 95% CI 1.45-3.85, P = 0.001) were predictors of poor prognosis in premature AMI patients. AMI in young patients is associated with unhealthy lifestyles such as smoking, dyslipidemia, and obesity. Low LVEF, elevated NT-proBNP peak level, and the occurrence of in-hospital MACCEs were predictors of poor prognosis in premature AMI patients.

BackgroundCurrent guidelines recommend culprit-only revascularisation (COR) in haemodynamically stable patients with ST-segment elevation myocardial infarction (STEMI) and multivessel (MV) disease. Contrarily, growing body of evidence available from recent randomised controlled...

The incidence of atherosclerotic cardiovascular disease (ASCVD) is increasing, with individuals experiencing acute myocardial infarction (AMI) at a younger age. Premature AMI is a serious condition with high rates of morbidity and mortality. This study aimed to identify clinical characteristics and risk factors associated with premature AMI and to evaluate the diagnostic value of those risk factors. The study collected data from first-time AMI patients who underwent coronary angiography at the hospital between January 2022 and April 2023. They were divided into two groups by age: premature AMI (men <55 years, women <65 years) and non-premature AMI. A control group of similar-aged patients without coronary artery disease was also included. Out of 388 patients with first-time AMI, 313 were male, and 249 had ST-segment elevation myocardial infarction (STEMI). Among 73 control patients, 31 were male. Those with premature AMI had more risk factors like smoking, overweight, obesity, family history of coronary artery disease, and STEMI. They also had shorter hospital stays and higher diastolic blood pressure and faster heart rates. Single-vessel lesions were more frequent in premature AMI patients. After adjusting for confounding factors, smoking status (Odds ratio (OR) 4.454, 95% confidence interval (CI): 1.836-10.806, p = 0.001), glycated hemoglobin (HbA1c) level (OR 2.261, 95% CI: 1.219-4.193, p = 0.010), the non-high-density lipoprotein cholesterol (non-HDL-C)/HDL-C ratio (OR 4.394, 95% CI: 1.204-16.031, p = 0.025), and the monocyte-to-high-density lipoprotein ratio (MHR) (OR 6.164, 95% CI: 1.386-27.417, p = 0.017) were identified as independent risk factors for premature AMI development. The combination of these risk factors provided the greatest predictive value for premature AMI (area under the curve (AUC) = 0.874, 95% CI: 0.826-0.922, p < 0.001, sensitivity = 0.843, specificity = 0.795). Premature AMI is often characterized by STEMI, single-vessel lesions, and a low occurrence of left main coronary artery involvement. Smoking status, HbA1c levels, the non-HDL-C/HDL-C ratio, and the MHR are significantly associated with premature AMI.

At present, the benefits associated with fractional flow reserve (FFR)-guided complete revascularization (CR) for instances of non-culprit stenosis in patients of coronary artery disease (CAD) affected by multivessel disease (MVD) remain poorly understood. This systematic review and meta-analysis was undertaken to clarify the cardiovascular benefits associated with FFR-guided and angiography-guided CR in patients with CAD and MVD. The PubMed, Embase, and Cochrane databases were searched to locate randomized control trials (RCTs) comparing FFR-guided CR with angiography-guided CR or culprit-only percutaneous intervention (PCI). The primary outcome is major adverse cardiovascular events (MACE), as well as secondary outcomes were all-cause mortality, cardiac mortality, recurrent myocardial infarction (MI) incidence. Primary and secondary outcomes were compared among groups using DerSimonian and Laird random-effects models. Ten RCTs enrolling 7249 participants were included. No significant differences were found between FFR- and angiography-guided CR use in patients with CAD and MVD in terms of MACE (RR: 0.88, 95%CI: 0.69-1.12, P = 0.302), cardiac mortality (RR: 0.90, 95%CI: 0.45-1.80. P = 1.000), recurrent MI (RR: 0.83, 95%CI: 0.55-1.25, P = 0.376), repeat revascularization (RR: 0.93, 95%CI: 0.71-1.21, P = 0.574), or target lesion revascularization (TLR; RR: 0.90, 95%CI: 0.33-2.48 P = 0.840). All-cause mortality was similar between the groups (RR: 1.00, 95%CI: 0.57-1.75, P = 1.000). Relative to culprit-only PCI, FFR-guided CR was associated with reduced risk of repeat revascularization (RR: 0.50, 95%CI: 0.37-0.68, P < 0.001) and TLR (RR: 0.31, 95%CI: 0.2-0.48, P < 0.001), while MACE incidence did not differ significantly between the two groups (RR: 0.72, 95%CI: 0.51-1.01, P = 0.006), nor did all-cause mortality (RR: 1.09, 95%CI: 0.84-1.42, P = 0.526), cardiac mortality (RR: 0.82, 95%CI: 0.55-1.21, P = 0.312), or recurrent MI (RR: 0.85, 95%CI: 0.73-1.24, P = 0.713). FFR-guided CR was found to linked with reduced repeat revascularization and TLR in individuals with CAD and MVD in comparison with culprit-only PCI. While no significant difference was detected between FFR-guided and angiography-guided CR procedures for the analyzed cardiovascular outcomes, a lower absolute number of adverse events was noted with FFR-guided CR. These findings indicate that the FFR-guided CR of non-culprit vessels may help reduce the need for the implantation of stents in patients with CAD and MVD without any adverse impact on their prognostic outcomes.