Premature MI patients had 43% higher risk of recurrent MI (HR 1.43) but similar revascularization risk compared to non-premature MI patients.
Does premature myocardial infarction (age ≤ 45 years) affect the long-term risk of MACCE and recurrent MI compared to non-premature MI in patients undergoing PCI?
Patients with premature MI (≤45 years) have a significantly higher risk of recurrent MI despite having fewer baseline comorbidities, highlighting the need for aggressive secondary prevention in this younger population.
Absolute Event Rate: 0% vs 0%
Abstract 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
Kim et al. (Sat,) は他のことを報告しました。早発MI患者は、非早発MI患者と比較して再発MIのリスクが43%高い（HR 1.43）が、再血行再建リスクは似ていました。