Young Acute Myocardial Infarction Research Articles

Prevalence and temporal trends of risk factors among young patients with acute myocardial infarction - a nationwide cohort study

Abstract Background Cardiovascular disease, including acute myocardial infarction (AMI) is the leading cause of death globally.(1) While the risk of AMI is higher with increasing age, the consequences of AMI can be more severe in younger individuals, causing larger loss-of-life-expectancy and imposing burdens for society in terms of healthcare costs and premature retirements. Description of the young AMI cohort is of greatest interest to identify modifiable risk factors and/or other predisposing factors that may be optimized. Aims To describe the prevalence and temporal trend of risk factors among young individuals with AMI. Methods We used data from the SWEDEHEART registry, the National Patient Registry, the Drug Prescription registry and the Swedish Population registry. Adult young patients, defined as 18-59 years, admitted with a first AMI from January 2003 to January 2022 were included. Prevalence of the potentially modifiable risk factors; hypertension, diabetes, hyperlipidemia, smoking and obesity was defined on admission. In the analyses the cohort was further divided into two age groups 18-44 and 45-59 years. Results From January 2003 to January 2022, 249 735 patients were admitted with a first AMI and among these, 50 281 (20.1% of the total AMI cohort) were classified as young and included in the study. 44 243 (88.0%) patients were 45-59 years and 6038 (12%) were 18-44 years. The overall prevalence of risk factors was substantial, with higher rates observed in women compared to men (Table 1a) and in the older age group, except for obesity, which was more common in the younger age group (Table 1b). While the prevalence of diabetes and hyperlipdemia remained unchanged over time, smoking decreased and hypertension slightly increased. Notably, the prevalence of obesity more than doubled (Figure 1). Conclusion Among young AMI patients the prevalence of modifiable risk factors was substantial with an even higher prevalence in women than in men. The increasing prevalence of obesity especially in the younger age group may indicate a potential future rising health care risks.Figure 1

Young female acute myocardial infarction patients have worse all-cause mortality compared to males: insights from a national myocardial infarction registry

Abstract Introduction Existing studies have examined the differences in presentation and outcomes between male and female patients with acute myocardial infarction (AMI). However, the translatability of these findings to young AMI patients is uncertain. In this study, we aimed to investigate sex differences in young AMI patients. Methods Retrospective data for all patients ≤50 years of age with a first-time AMI occurring between 2007 and 2020 were analysed from a national myocardial infarction registry. We examined the outcomes of overall survival and cardiovascular-related survival. Cox proportional hazards regression was used to assess the association of survival with various covariates. Effect estimates were summarized using hazard ratios (HRs) and 95%-confidence intervals (95%CI). Results A total of 12435 patients was analyzed, of which 1699 (13.7%) were female. Onset age of first-time AMI was not significantly different between males (46.0 interquartile range (42.0, 48.0)) and females (46.0 interquartile range (42.0, 48.0)). Compared to males, more females had atypical symptoms (26% vs 22%, p<0.001), hypertension (54% vs 43%, p<0.001), diabetes mellitus (47% vs 32%, p<0.001). Fewer females had hyperlipidemia (53% vs 62%, p<0.001). The median follow-up time was 7.71 years (IQR (4.34, 11.22)). When adjusted for race, age of onset, heart failure status at admission, hyperlipidemia, diabetes mellitus, hypertension, previous percutaneous coronary intervention and chest pain at presentation, females had significantly higher all-cause mortality (adjusted HR: 1.30 (95%CI: 1.18, 1.45)) (Figure 1). Conclusion In conclusion, females who had first-time AMI under 50 years old were more likely to present atypically and have worse all-cause mortality.Figure 1

Clinical Profiles and Risk Factors of Acute Myocardial Infarction in Young Adults: A Cross-Sectional Study in Myanmar.

Introduction Coronary artery disease (CAD) remains a leading cause of morbidity and mortality globally, with an increasing prevalence of acute myocardial infarction (AMI) among younger populations. Despite this rising trend, there are limited data from Myanmar on the clinical profile and associated risk factors for premature CAD in young adults. This study aims to investigate the clinical characteristics and predisposing risk factors for AMI in individuals aged 40 years and below, contributing to a better understanding of disease patterns in this population. Methods A cross-sectional descriptive study was conducted at the coronary care unit of Yangon General Hospital over a 12-month period from January 1, 2019, to December 31, 2019. A total of 59 young adults, diagnosed with AMI based on the Fourth Universal Definition of Myocardial Infarction, were included. Clinical data, laboratory investigations, and demographic characteristics were collected and analyzed. Results Among the 59 participants, 46 (78%) were male, and smoking was prevalent in 45 (76.3%) cases. Dyslipidemia was common, with 46 (77.9%) exhibiting low high-density lipoprotein (HDL) cholesterol levels and 27 (45.8%) having elevated total cholesterol. Hypertension was observed in 31 (52.5%) patients, and 32 (54.2%) reported a family history of premature atherosclerotic cardiovascular disease. Furthermore, 28 (47.5%) of the cohort were classified as overweight, and 26 (44.1%) demonstrated low levels of physical activity. Chest pain was universally reported by all 59 (100%) patients as the presenting symptom. ST-segment elevation myocardial infarction (STEMI) was the predominant type, affecting 47 (79.6%) patients, with anterior wall involvement in 36 (61%) cases. Conclusion The findings of this study reveal that AMI in young adults is more prevalent among males, with smoking and dyslipidemia being the most significant risk factors. The high prevalence of low physical activity, hypertension, and overweight status further underscores the need for early lifestyle interventions. These results can be directly applied to clinical practice and public health policy in Myanmar by prioritizing smoking cessation programs, improving dyslipidemia management, and promoting physical activity in young populations. Additionally, this study provides a foundation for further research to explore more specific risk factors and paves the way for broader studies focusing on young AMI cases in Myanmar.

Factors associated with return to work after acute myocardial infarction: A systematic review and meta-analysis.

The incidence of young acute myocardial infarction (AMI) is increasing. Return-to-work is an important indicator for patients' psycho-social recovery. However, factors influencing return-to-work after AMI are yet to be determined. To summary available evidence on rate and factors associated with return-to-work among AMI patients. The Cochrane Library, PubMed, Embase, Web of Science, Scopes and two Chinese databases (CNKI and VIP) were searched from inception to October 3, 2023. Pooled rate of return-to-work (%) and odds ratio (OR) were calculated with Stata 17 software. Of 2403 records screened, 19 studies were included. Pooled rate of return-to-work at 3, 6, 12, and 24 and above months after AMI was 74%, 87%, 87%, 80% respectively. Factors associated with lower rate of return-to-work were comorbidity of diabetes (OR = 0.65; 95% CI, 0.46-0.93), history of heart failure (OR = 0.43; 95% CI, 0.23-0.80), manual labor (OR = 0.51; 95% CI, 0.35-0.76) and depression (OR = 0.59; 95% CI, 0.37-0.93). Male (OR = 1.42; 95% CI, 1.09-1.85) and higher education level (OR = 1.45; 95% CI, 1.25-1.69) were protective factors. Age, marital status and smoking were not significantly associated with return-to-work. More than half of patients could return to work at 3-month post-AMI, return-to-work rate was increased during one-year post-AMI followed by a decrease. Comorbidity of diabetes, history of heart failure, manual labor and depression were negative predictors of return-to-work, while male and higher education level were protective factors. This would assist the professionals to identify the patient who was risk for unable to return-to-work and provide support for AMI patents.

Environmental Temperature, Other Climatic Variables, and Cardiometabolic Profile in Acute Myocardial Infarction.

Objectives: To evaluate CV profiles, periprocedural complications, and in-hospital mortality in acute myocardial infarction (AMI) according to climate. Methods: Data from 2478 AMI patients (1779 men; mean age 67 ∓ 13 years; Pasquinucci Hospital ICU, Massa, Italy; 2007-2018) were retrospectively analyzed according to climate (LAMMA Consortium; Firenze, Italy) by using three approaches as follows: (1) annual warm (May-October) and cold (November-April) periods; (2) warm and cold extremes of the two periods; and (3) warm and cold extremes for each month of the two periods. Results: All approaches highlighted a higher percentage of AMI hospitalization for patients with adverse CV profiles in relation to low temperatures, or higher periprocedural complications and in-hospital deaths. In warmer times of the cold periods, there were fewer admissions of dyslipidemic patients. During warm periods, progressive heat anomalies were characterized by more smoker (approaches 2 and 3) and young AMI patient (approach 3) admissions, whereas cooler times (approach 3) evidenced a reduced hospitalization of diabetic and dyslipidemic patients. No significant effects were observed for the heat index and light circulation. Conclusions: Although largely overlapping, different approaches identify patient subgroups with different CV risk factors at higher AMI admission risk and adverse short-term outcomes. These data retain potential implications regarding pathophysiological mechanisms of AMI and its prevention.

LPA Gene Copy Number Variation and APOE Gene Polymorphism in Young Acute Myocardial Infarction

INTRODUCTION: An early onset of acute myocardial infarction (AMI) and a strong family history suggest the possibility of its genetic predisposition. Lipoprotein(a) (LPA) and Apolipoprotein E (APOE) genes are known to be involved in lipid metabolism which may contribute to the development of atherosclerosis leading to AMI. This study aims to assess the association between LPA gene copy number variation (CNV) and APOE gene polymorphism in young AMI patients. MATERIALS AND METHODS: A total of 40 DNAs were extracted from the buffy coat. APOE genotyping and detection of LPA gene CNV were performed using multiplex PCR technique and digital PCR. After tabulation of the results of the current study, meta-analyses were performed from selected studies among Asian populations using the Comprehensive Meta-analysis version 3 software program. RESULTS: No significant association was found between CNV of the LPA gene and the polymorphism of the APOE gene with Young AMI patients in the current study. However, our meta-analysis confirmed that the E4 allele increased the risk for CAD with the E3/E4 genotype [p=0.000, OR= 1.60 (95% CI: 1.41-1.83) significantly increased risk of CAD and individuals with E3/E3 genotype [p=0.000, OR=0.73 (95% CI: 0.66-0.81) were protective against CAD. The gain of LPA CNV was higher in YAMI [n=5 (25%)] than in control [n=2 (10%)] but they are not significant. CONCLUSION: There is no association between the LPA gene CNV and the presence of APOE polymorphism in young AMI, but our meta-analysis confirmed that the E4 allele increased the risk for CAD.

Young hearts at risk: Unveiling novel factors in myocardial infarction susceptibility and prevention.

The increasing incidence of acute myocardial infarction (AMI) among the young population represents a significant and emerging health concern, contributing substantially to both mortality and morbidity. Unlike myocardial infarctions occurring in older individuals, traditional risk factors such as diabetes and hypertension exhibit a weaker association in the younger demographic. Consequently, there is a pressing need for a deeper understanding of novel risk factors that contribute to AMI in young patients. In this review, we explore distinct risk factor profiles associated with young-onset AMI in comparison to older patients. Special attention is given to novel risk factors, examining their susceptibility factors and exploring preventive measures. The comprehensive risk profile of extremely young South Asians who develop early coronary arterial disease is not yet fully understood. There are many novel evolving risk factors associated with young AMI which need intervention to reduce morbidity and mortality. It has been seen that established inflammatory markers like lipoprotein (a), dyslipidaemia, long COVID, and new emerging risk factors like air pollution (micro- and nanoplastics), periodontitis, acute stress, energy drinks, misuse of recreational drugs may increase risk and influence treatment, and outcomes of AMI in this young population. Screening of emerging novel risk markers and their optimization is important in preventing young patients with AMI. The role of conventional risk factors should not be overlooked and should be treated aggressively. Sex and geographic-specific base approaches are required to reduce risk factors and prevent AMI in young. More prospective studies are needed to evaluate the increasing incidence of young AMI and its associated novel risk factors.

ST elevation acute myocardial infarction in young versus elderly: An observational study

ABSTRACT Background: ST elevation acute myocardial infarction (AMI) is usually associated with marked morbidity and mortality, affecting both young and elderly populations. Aims: To compare the differences in clinical presentation, treatment, outcome, and comorbidity in elderly and young patients of ST elevation myocardial infarction (STEMI). Methods: A prospective study was conducted on 60 patients divided equally into two groups – above 60 years (Group A) and 60 years or below (Group B). The various parameters including clinical presentation, time of onset, type of AMI, medication, complications, and outcome were assessed. They were followed up for 1 month. Results: The proportion of males and females (M:F) was equal in Group A, and the M:F ratio was 2.75 in Group B. The mean duration of hospitalization was longer in elderly. Hypertension was the most common comorbid condition. About half of the elderly cohort had previous history of angina pectoris, and about one third had prior attacks of MI. Overall, a higher number of younger cohorts were thrombolyzed with streptokinase. Conclusion: Our study showed that there were noteworthy differences in clinical presentation, management, and outcome between elderly and young AMI patients. Early recognition of atypical features among elderly can lead to effective strategies and timely management.

Association of marital/partner status with hospital readmission among young adults with acute myocardial infarction.

Despite evidence supporting the benefits of marriage on cardiovascular health, the impact of marital/partner status on the long-term readmission of young acute myocardial infarction (AMI) survivors is less clear. We examined the association between marital/partner status and 1-year all-cause readmission and explored sex differences among young AMI survivors. Data were from the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients), which enrolled young adults aged 18-55 years with AMI (2008-2012). The primary end point was all-cause readmission within 1 year of hospital discharge, obtained from medical records and patient interviews and adjudicated by a physician panel. We performed Cox proportional hazards models with sequential adjustment for demographic, socioeconomic, clinical, and psychosocial factors. Sex-marital/partner status interaction was also tested. Of the 2,979 adults with AMI (2002 women [67.2%]; mean age 48 [interquartile range, 44-52] years), unpartnered individuals were more likely to experience all-cause readmissions compared with married/partnered individuals within the first year after hospital discharge (34.6% versus 27.2%, hazard ratio [HR] = 1.31; 95% confidence interval [CI], 1.15-1.49). The association attenuated but remained significant after adjustment for demographic and socioeconomic factors (adjusted HR, 1.16; 95% CI, 1.01-1.34), and it was not significant after further adjusting for clinical factors and psychosocial factors (adjusted HR, 1.10; 95%CI, 0.94-1.28). A sex-marital/partner status interaction was not significant (p = 0.69). Sensitivity analysis using data with multiple imputation and restricting outcomes to cardiac readmission yielded comparable results. In a cohort of young adults aged 18-55 years, unpartnered status was associated with 1.3-fold increased risk of all-cause readmission within 1 year of AMI discharge. Further adjustment for demographic, socioeconomic, clinical, and psychosocial factors attenuated the association, suggesting that these factors may explain disparities in readmission between married/partnered versus unpartnered young adults. Whereas young women experienced more readmission compared to similar-aged men, the association between marital/partner status and 1-year readmission did not vary by sex.

Psychosocial adaptation profiles in young and middle-aged patients with acute myocardial infarction: a latent profile analysis.

We sought to explore the latent classifications of psychosocial adaptation in young and middle-aged patients with acute myocardial infarction (AMI) and analyse the characteristics of different profiles of AMI patients. A cross-sectional study was performed in 438 Chinese young and middle-aged patients with AMI. The investigation time was 1 month after discharge. Three different self-report instruments were distributed to the participants, including the Psychosocial Adjustment to Illness Scale, the Perceived Stress Scale, and the Social Support Rating Scale. The seven dimensions of the Psychosocial Adjustment to Illness Scale were then used to perform a latent profile analysis. All participants signed informed consent forms in accordance with the ethical principles of the Declaration of Helsinki. Finally, a total of 411 young and middle-aged AMI patients were enrolled. Three distinct profiles were identified, including the 'well-adapted group' (44.8%), 'highlight in psychological burdens group' (25.5%), and 'poorly adapted group' (29.7%). The influencing factors included stress perception, social support, occupational type, and marital status (P < 0.05). The psychosocial adaptation of young and middle-aged AMI patients can be divided into three profiles. Clinical nurses can carry out individualized psychological interventions according to the characteristics of patients in different potential profiles to improve the psychosocial adaptation of patients and the prognosis of their disease.

Effects of posttraumatic growth on psychosocial adjustment in young and middle-aged patients with acute myocardial infarction: The mediating role of rumination

BackgroundPsychosocial adjustment is a core problem faced by young and middle-aged patients following a diagnosis of acute myocardial infarction (AMI), which seriously affects rehabilitation outcomes. However, the relationship and influencing mechanism between post-traumatic growth and psychosocial adjustment in young and middle-aged AMI patients have not been fully explored. ObjectivesThis study aimed to determine the relationship between posttraumatic growth and psychosocial adjustment in young and middle-aged patients following AMI and to explore the mediating role of rumination. MethodsThis cross-sectional study was conducted in Guangdong Province from January 2022 to August 2022. A total of 321 young to middle-aged patients with AMI participated in this study. Self-reported questionnaires were used to assess posttraumatic growth, rumination, and psychosocial adjustment. Pearson's correlation and path analyses were used to analyze the data. ResultsThe total scores for posttraumatic growth, rumination, and psychosocial adjustment in young and middle-aged patients with AMI were 51.24±19.35, 35.18±8.72, and 43.55±26.04, respectively. All three were considered moderate. Posttraumatic growth was positively associated with rumination and negatively associated with psychosocial adjustment (p < 0.01). The relationship between posttraumatic growth and psychosocial adjustment was mediated by deliberate rumination. ConclusionsDeliberate rumination mediated the relationship between posttraumatic growth and psychosocial adjustment. Healthcare providers should therefore guide patients to engage in deliberate rumination to help them grow following their AMI, thereby improving their psychosocial adaptability and prognosis.

Sex Difference in Outcomes of Acute Myocardial Infarction in Young Patients

BackgroundYounger women experience worse health status than men after their index episode of acute myocardial infarction (AMI). However, whether women have a higher risk for cardiovascular and noncardiovascular hospitalizations in the year after discharge is unknown. ObjectivesThe aim of this study was to determine sex differences in causes and timing of 1-year outcomes after AMI in people aged 18 to 55 years. MethodsData from the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study, which enrolled young patients with AMI across 103 U.S. hospitals, were used. Sex differences in all-cause and cause-specific hospitalizations were compared by calculating incidence rates ([IRs] per 1,000 person-years) and IR ratios with 95% CIs. We then performed sequential modeling to evaluate the sex difference by calculating subdistribution HRs (SHRs) accounting for deaths. ResultsAmong 2,979 patients, at least 1 hospitalization occurred among 905 patients (30.4%) in the year after discharge. The leading causes of hospitalization were coronary related (IR: 171.8 [95% CI: 153.6-192.2] among women vs 117.8 [95% CI: 97.3-142.6] among men), followed by noncardiac hospitalization (IR: 145.8 [95% CI: 129.2-164.5] among women vs 69.6 [95% CI: 54.5-88.9] among men). Furthermore, a sex difference was present for coronary-related hospitalizations (SHR: 1.33; 95% CI: 1.04-1.70; P = 0.02) and noncardiac hospitalizations (SHR: 1.51; 95% CI: 1.13-2.07; P = 0.01). ConclusionsYoung women with AMI experience more adverse outcomes than men in the year after discharge. Coronary-related hospitalizations were most common, but noncardiac hospitalizations showed the most significant sex disparity.

Abstract P405: Low Social Support Mediates the Effect of Marital Stress on 12-month Cardiac-Specific Quality of Life in Young Adults With Acute Myocardial Infarction

Background: Marital stress is associated with worse cardiac outcomes in young adults (≤55 years) with acute myocardial infarction (AMI), but whether psychosocial factors mediate this association remains largely unknown. We conducted a mediation analysis to investigate whether marital stress worsened quality of life (QoL) after AMI by increasing the likelihood of depression or low social support. Methods: There were 1,037 married/partnered AMI survivors aged 18-55 years enrolled in the VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study (2008-2012) (67% women, mean age 47 years). Marital stress was measured by the Stockholm Marital Stress Scale at 1 month post-AMI; categorized as absent/moderate or severe. Depression (Patient Health Questionnaire-9 score ≥10), low social support (ENRICHD Social Support Instrument score ≤3 on ≥2 items and total score ≤18), and cardiac-specific QoL (Seattle Angina Questionnaire) were assessed at 1 year post-AMI. Natural direct and indirect effects of marital stress, depression, and low social support on QoL were estimated by causal mediation analysis with bias-corrected bootstrapped confidence intervals. Baseline QoL, sex, age, race, and socioeconomic factors (education, income, employment, and insurance status) were entered as covariates in all models. Results: There was a statistically significant direct effect from severe marital stress to lower 1-year cardiac-specific QoL after adjusting for covariates ( Figure ). Low social support and depression mediated 14.7% and 11.1% of the total relationship between marital stress and QoL, respectively; however, only the mediating effect through low social support was statistically significant. Conclusion: Marital stress was significantly associated with worse 1-year cardiac-specific QoL, and this effect was partially mediated by low social support. Interventions to decrease marital stress that also screen and provide resources for social support may help to improve AMI outcomes.

Association of Sociodemographic Characteristics With 1-Year Hospital Readmission Among Adults Aged 18 to 55 Years With Acute Myocardial Infarction

Among younger adults, the association between Black race and postdischarge readmission after hospitalization for acute myocardial infarction (AMI) is insufficiently described. To examine whether racial differences exist in all-cause 1-year hospital readmission among younger adults hospitalized for AMI and whether that difference retains significance after adjustment for cardiac factors and social determinants of health (SDOHs). The VIRGO (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients) study was an observational cohort study of younger adults (aged 18-55 years) hospitalized for AMI with a 2:1 female-to-male ratio across 103 US hospitals from January 1, 2008, to December 31, 2012. Data analysis was performed from August 1 to December 31, 2021. The primary outcome was all-cause readmission, defined as any hospital or observation stay greater than 24 hours within 1 year of discharge, identified through medical record abstraction and clinician adjudication. Logistic regression with sequential adjustment evaluated racial differences and potential moderation by sex and SDOHs. The Blinder-Oaxaca decomposition quantified how much of any racial difference was explained and not explained by covariates. This study included 2822 participants (median [IQR] age, 48 [44-52] years; 1910 [67.7%] female; 2289 [81.1%] White and 533 [18.9%] Black; 868 [30.8%] readmitted). Black individuals had a higher rate of readmission than White individuals (210 [39.4%] vs 658 [28.8%], P < .001), particularly Black women (179 of 425 [42.1%]). After adjustment for sociodemographic characteristics, cardiac factors, and SDOHs, the odds of readmission were 34% higher among Black individuals (odds ratio [OR], 1.34; 95% CI, 1.06-1.68). The association between Black race and 1-year readmission was positively moderated by unemployment (OR, 1.68; 95% CI, 1.09- 2.59; P for interaction = .02) and fewer number of working hours per week (OR, 1.01; 95% CI, 1.00-1.02; P for interaction = .01) but not by sex. Decomposition indicates that 79% of the racial difference in risk of readmission went unexplained by the included covariates. In this multicenter study of younger adults hospitalized for AMI, Black individuals were more often readmitted in the year following discharge than White individuals. Although interventions to address SDOHs and employment may help decrease racial differences in 1-year readmission, more study is needed on the 79% of the racial difference not explained by the included covariates.

Young Women With Acute Myocardial Infarction: Risk Prediction Model for 1-Year Hospital Readmission

BackgroundAlthough young women ( aged ≤ 55 years) are at higher risk than similarly aged men for hospital readmission within 1 year after an acute myocardial infarction (AMI), no risk prediction models have been developed for them. The present study developed and internally validated a risk prediction model of 1-year post-AMI hospital readmission among young women that considered demographic, clinical, and gender-related variables. MethodsWe used data from the US Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study (n = 2007 women), a prospective observational study of young patients hospitalized with AMI. Bayesian model averaging was used for model selection and bootstrapping for internal validation. Model calibration and discrimination were respectively assessed with calibration plots and area under the curve. ResultsWithin 1-year post-AMI, 684 women (34.1%) were readmitted to the hospital at least once. The final model predictors included: any in-hospital complication, baseline perceived physical health, obstructive coronary artery disease, diabetes, history of congestive heart failure, low income ( < $30,000 US), depressive symptoms, length of hospital stay, and race (White vs Black). Of the 9 retained predictors, 3 were gender-related. The model was well calibrated and exhibited modest discrimination (area under the curve = 0.66). ConclusionsOur female-specific risk model was developed and internally validated in a cohort of young female patients hospitalized with AMI and can be used to predict risk of readmission. Whereas clinical factors were the strongest predictors, the model included several gender-related variables (ie, perceived physical health, depression, income level). However, discrimination was modest, indicating that other unmeasured factors contribute to variability in hospital readmission risk among younger women.

Abstract 14359: Impact of Marital Stress on 12-month Health Outcomes Among Young Adults With Acute Myocardial Infarction

Background: Psychosocial stress is associated with worse cardiac outcomes, but little is known about the prognostic impact of marital stress in young adults (≤55 years) with acute myocardial infarction (AMI). We investigated the association between marital stress and 1-year health outcomes in young AMI survivors. Methods: We used data from the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients), which enrolled people aged 18-55 years with AMI (2008-2012). Marital stress was assessed among married/partnered participants at 1 month post-AMI using the Stockholm Marital Stress Scale, categorized as absent/mild, moderate, and severe. Main outcomes were physical/mental health status, generic/disease-specific quality of life, angina, depressive symptoms, and all-cause readmission at 1 year post-AMI. Linear and logistic regression models were sequentially adjusted for baseline health status, demographics, and socioeconomic factors (including education level, income level, employment status, and insurance status). Results: Among the 1593 married/partnered participants in our study, more women reported severe marital stress than men (39.4% vs 30.4%, p=0.001). Having severe marital stress was associated with worse physical and mental health, lower generic and cardiovascular-specific quality of life, more angina and depressive symptoms, and 1.48 times higher all-cause readmission at 1 year post-AMI. These associations remained significant after adjusting for baseline health score and patient demographics ( Table Model 1 ), but they attenuated and became non-significant when further adjusting for socioeconomic factors ( Model 2 ). Conclusion: Marital stress was associated with worse health outcomes in young AMI patients, which can be partially mediated by socioeconomic factors. Further research is needed to understand this complex relationship and potential causal pathway associated with these findings.

Abstract 9234: Evaluating the Association Between Perceived Discrimination and Health Status Outcomes Among Young Adults Hospitalized for Acute Myocardial Infarction

Background: Perceived discrimination is associated with several risk factors for acute myocardial infarction (AMI), but little is known about the association between discrimination and health status outcomes post-AMI. Methods: We analyzed the 1- and 12-month health status of 2,670 young (≤ 55 years) adults recovering from an AMI enrolled in the VIRGO study (Variation in Recovery: Role of Gender on Outcomes of Young AMI Patients). Perceived discrimination was assessed using the Everyday Discrimination Scale (EDS). General health status was measured using the Short Form 12 Physical and Mental Component Scores (PCS and MCS). Disease-specific health status was measured using the following domains of the Seattle Angina Questionnaire (SAQ): treatment satisfaction (TS), quality of life (QL) and dichotomous forms of the physical limitation and angina frequency domain scores (score &lt; 100). Lower scores indicate worse health status. Multivariable linear regression of the PCS, MCS, TS, and QL scores and multivariable logistic regression of the dichotomous forms of physical limitation and angina frequency were used to assess their adjusted associations with perceived discrimination. Results: Nearly 35.0% of the cohort reported discrimination (EDS &gt; 0). At 1-month post-AMI, increased EDS score was significantly associated with lower MCS, TS, and QL scores and higher odds of physical limitation and angina after adjustment (Figure) . At 12-months post-AMI, increased EDS score retained its significant associations with lower MCS and QL scores and higher odds of physical limitation and angina, but not its association with TS (Figure) . The EDS score was not associated with PCS at either 1- or 12-months post-AMI. Conclusions: Perceived discrimination was associated with worse mental health and disease-specific health status one year after AMI after adjusting important confounders. Further work to understand the source and how to mitigate perceived discrimination is needed.

Age-related difference in the impact of diabetes mellitus on all-cause mortality after acute myocardial infarction

Abstract Background Diabetes mellitus (DM) is highly prevalent among individuals hospitalized with acute myocardial infarction (AMI) and is associated with increased risk for cardiovascular complications and short-term and long-term mortality. However, most existing data are from older patients. Little is known about the incidence of diabetes in individuals who experience AMI at a young age. Whether the presence of DM is associated with worse outcomes in these patients is not clear. Purpose To test the hypothesis that the impact of DM on clinical outcomes after AMI can vary by age. Methods A total of 12,600 AMI patients from the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) between November 2011 and December 2015 was classified into young (n=3,590 [28.5%]) and elderly (n=9,010 [71.5%]). Those less than 55 years of age were considered young. We performed comparisons of baseline characteristics, in-hospital treatments, and long-term clinical outcomes between patients with and without diabetes after stratification according to age group. Results The prevalence of diabetes mellitus was 26.5% in the young AMI group. In the multivariable-adjusted model of the entire cohort, diabetes mellitus was associated strongly with 3-year all-cause mortality (12.6% vs. 6.8%; adjusted hazard ratio [HR], 1.318; 95% confidence interval [CI], 1.138–1.526; P&amp;lt;0.001). When the entire cohort was subdivided into two age groups, young diabetic patients showed a 107.0% higher mortality rate than those without diabetes (adjusted HR, 2.070; 95% CI, 1.150–3.724; P=0.015). Meanwhile, elderly diabetic patients had a 25.3% higher risk of mortality than non-diabetic patients (adjusted HR, 1.253; 95% CI, 1.076–1.459; P=0.004). The interaction of diabetes with age was significant (adjusted P for interaction = 0.008). Conclusion DM is not uncommon in younger AMI patients, and the relative risk of long-term mortality is significantly higher in young patients than in older counterparts. More aggressive treatments are needed to prevent future cardiovascular events in younger patients after AMI. Funding Acknowledgement Type of funding sources: None.

MicroRNAs Expression Profile in Young Patients with Acute Myocardial Infarction

Introduction: Acute myocardial infarction (AMI) is a severe coronary heart disease. Targeted miRNAs studies implicated two main pathways in the regulation of AMI namely pro-apoptosis (miR-29b and miR-194-5p on PTEN) and pro-necroptosis (miR-325 &amp; miR-105 on RIPK3 ) pathways. This study aims to profile the miRNAs in Healthy Controls, Young AMI, and Mature AMI patients with matching criteria. MATERIALS AND Methods: Total RNA was extracted from plasma and the miRNA expression profiling using small RNA was done on the BGISEQ500 SE5 sequencing platform with BGI sequencing libraries. The sequence data were analysed using Gene Ontology (GO) to determine the function of the differently expressed genes, while Kyoto Encyclopaedia of Genes and Genomes (KEGG) enrichment analyses were applied to identify the biological pathways in Young AMI against Mature AMI. Results: Of 1497 differentially expressed miRNAs, 1090 miRNAs were upregulated, and 407 miRNAs were downregulated in Young AMI against Mature AMI. The top 10 upregulated miRNAs were miR-552, miR-4446-3p, miR-432-5p, miR-548j-5p, miR-219, miR-982, miR-181a-2-3p, miR-654-5p, miR-58 and miR-548k; while the top 10 downregulated were miR-16-5p, miR-1064, miR-431-5p, miR-790 miR-1177, miR-201, miR-105, miR-518, miR-419 and miR-1103. There were 9 novel miRNAs discovered in this study; miR-58, miR-982, miR-548k, miR-1064, miR-790, miR-1177, miR-201, miR-419, and miR-1103. The target genes of differentially expressed miRNAs that were mapped to the signal transduction pathway in KEGG indicated that 346 classes were enriched. Conclusion: Our miRNA profiling revealed differentially expressed miRNAs including 9 novel miRNAs in Young and Mature AMI that require further evaluations for their roles in AMI.

Analysis of clinical characteristics and risk factors of young acute myocardial infarction

OBJECTIVE: The aim of the study is to investigate the clinical characteristics and risk factors for the development of young acute myocardial infarction (AMI). METHODS: A number of 196 AMI patients (31 young patients and 165 older patients) were enrolled in the study. The clinical characteristics in young AMI patients were explored by comparing their baseline characteristics, imaging features and serological results. The risk factors were tested by logistics regression analysis. RESULTS: The younger AMI patients were more likely to have hyperlipidaemia (67.74% vs. 36.97%, P=0.002), a family history of coronary heart disease and hyperlipidaemia (29.03% vs. 12.12%, P=0.025) (51.61% vs. 18.79%, P&lt;0.001), (54.84% vs. 35.15%, P=0.045) (61.29% vs. 34.55%, P=0.008). The proportion of alcohol and tobacco use were higher in younger AMI group. More severe anterior descending lesions involvement (77.42% vs. 46.06%, P=0.002) and a higher Gensini scores (62.23±16.80) vs. (53.00±18.58), P=0.011) were found in CTA imagines of younger AMI patients. The triglyceride levels were also significantly higher in younger AMI patients (2.55±1.59) vs. (1.67±0.79), P=0.005). A family history of hyperlipidaemia, Gensini score, IL-6 and triglycerides were risk factors for young AMI patients. CONCLUSION: Poor lifestyle management and family history were risk factors for the AMI development in young patients.