Figure 1
Study flowchart. A total of 303 patients were initially screened for eligibility. Of these, 97 were excluded based on the predefined exclusion criteria. The final study population comprised 206 patients, stratified according to age into two groups: 100 patients in the older STEMI group (G1, age >50 years) and 106 patients in the younger STEMI group (G2, age ≤50 years). STEMI, ST-segment elevation myocardial infarction.
Table 1
Population risk profile
| General population (n = 206) | G1 (n = 100) | G2 (n = 106) | p | |
|---|---|---|---|---|
| Mean age (years) | 52.8 ± 11.6 | 62.2 ± 7.9 | 43.3 ± 5.2 | p < 0.05 |
| Female gender (%) | 36 (17.5) | 25 (25) | 11 (10.4) | p < 0.05 |
| Family history CAD (%) | 31 (15) | 7 (7) | 24 (22.6) | p < 0.05 |
| HTN (%) | 64 (31.1) | 39 (39) | 25 (23.6) | p < 0.05 |
| DM (%) | 101 (49) | 58 (58) | 43 (40.6) | p < 0.05 |
| CVA (%) | 7 (3.4) | 7 (7) | 0 (0) | p < 0.05 |
| Dyslipidaemia (%) | 32 (15.5) | 16 (16) | 16 (15.1) | p = 0.86 |
| Obesity (%) | 17 (8.3) | 6 (6) | 11 (10.4) | p = 0.25 |
| Former smoker (%) | 11 (5.3) | 5 (5) | 6 (5.7) | p = 0.83 |
| Current smoker (%) | 150 (72.8) | 60 (60) | 90 (84.9) | p < 0.0001 |
| CHAU (%) | 39 (18.9) | 7 (7) | 32 (30.2) | p < 0.0001 |
| Cannabis use (%) | 14 (6.8) | 2 (2) | 12 (11.3) | p < 0.05 |
| Cocaine use (%) | 1 (0.5) | 0 (0) | 1 (0.9) | p = 0.33 |
| CKD (%) | 4 (1.9) | 1 (1) | 3 (2.8) | p = 0.34 |
| AAD (%) | 2 (1) | 0 (0) | 2 (1.9) | p = 0.17 |
| AF (%) | 5 (2.4) | 5 (5) | 0 (0) | p < 0.05 |
Table 2
Clinical presentation in general population.
| General population (n = 206) | G1 (n = 100) | G2 (n = 106) | p | |
|---|---|---|---|---|
| Anterior MI (%) | 90 (43.7) | 43 (43) | 47 (44.3) | 0.57 |
| Inferior MI (%) | 81 (39.3) | 42 (42) | 39 (36.8) | 0.08 |
| LBBB (%) | 3 (1.5) | 3 (3) | 0 (0) | 0.07 |
| Time from pain to first contact (hr) | 10.7 ± 13.6 | 12.72 ± 14.62 | 8.8 ± 12.3 | <0.05 |
| Subacute STEMI presentation (%) | 52 (25.2) | 31 (31) | 21 (19.8) | 0.06 |
| HR (bpm) | 81.3 ± 16 | 81 ± 16.1 | 81.7 ± 16.0 | 0.75 |
| CS (%) | 18 (8.7) | 11 (11) | 7 (6.6) | 0.26 |
| AHF (%) | 43 (20.9) | 20 (20) | 23 (21.7) | 0.76 |
| VT/VF (%) | 9 (4.4) | 3 (3) | 6 (5.7) | 0.35 |
| AVB (%) | 11 (5.3) | 8 (8) | 3 (2.8) | 0.09 |
| Resuscitated CA (%) | 5 (2.4) | 2 (2) | 3 (2.8) | 0.7 |
| LVEF (%) | 47.6 ± 12 | 47.2 ± 12.3 | 47.9 ± 11.7 | 0.67 |
| Reduced LVEF ≤ 40% (%) | 67 (32.5) | 34 (34) | 33 (31.1) | 0.89 |
| LDL-C (g/L) | 1.2 ± 0.4 | 1.2 ± 0.5 | 1.2 ± 0.4 | 0.81 |
| HbA1c (%) | 7 ± 2.2 | 8.0 ± 2.7 | 6.4 ± 1.8 | <0.05 |
| Creatinine (μmol/L) | 85.5 ± 49.4 | 89.7 ± 57.5 | 81.5 ± 40 | 0.24 |
| Troponins (ng/L) | 18 640 ± 14 989.6 | 19115 ± 16099.6 | 18232 ± 14043.2 | 0.7 |
| Hyperhomocysteinemia (%) | 2 (1) | 0 (0) | 2 (1.9) | 0.05 |
| Thrombophilia (%) | 2 (1) | 0 (0) | 2 (1.9) | 0.05 |
| APS (%) | 1 (0.5) | 0 (0) | 1 (0.9) | 0.24 |
1 AHF, acute heart failure; APS, antiphospholipid syndrome; AVB, atrioventricular block; CA, cardiac arrest; CS, cardiogenic shock; HbA1c, glycated haemoglobin; hyperhomocysteinemia, elevated homocysteine levels; HR, heart rate; LBBB, left bundle branch block; LDL, low-density lipoprotein; LVEF, left ventricular ejection fraction; troponins, troponin levels; MI, myocardial infarction; RBBB, right bundle branch block; STEMI, ST-elevation myocardial infarction; VF, ventricular fibrillation; VT, ventricular tachycardia.
Table 3
Angiographic findings in the general population
| General population (n = 206) | G1 (n = 100) | G2 (n = 106) | p | |
|---|---|---|---|---|
| Primary PCI (%) | 129 (62.6) | 61 (61) | 68 (64.2) | 0.78 |
| Rescue PCI (%) | 16 (7.8) | 10 (10) | 6 (5.7) | 0.15 |
| Radial access (%) | 184 (89.3) | 90 (90) | 94 (88.7) | 0.76 |
| High thrombotic burden (%) | 28 (13.6) | 8 (8) | 20 (18.9) | <0.05 |
| Coronary status | ||||
| Single-vessel (%) | 92 (44.7) | 31 (31) | 61 (57.5) | <0.05 |
| Multivessel (%) | 105 (50.9) | 66 (66) | 39 (36.8) | <0.05 |
| Syntax score | 13.3 ± 11.9 | 16.7 ± 13.8 | 10.0 ± 8.9 | <0.01 |
| Culprit vessel | ||||
| LAD (%) | 96 (46.6) | 44 (44) | 52 (49.1) | 0.45 |
| RCA (%) | 67 (32.5) | 36 (36) | 31 (29.2) | 0.31 |
| LMCA (%) | 3 (1.5) | 2 (2) | 1 (0.9) | 0.9 |
| Cx (%) | 19 (9.2) | 13 (13) | 6 (5.7) | 0.08 |
| Pre-revascularisation TIMI | ||||
| 0 (%) | 71 (34.5) | 33 (33) | 38 (35.8) | 0.14 |
| II (%) | 31 (15) | 19 (19) | 12 (11.3) | 0.14 |
| III (%) | 95 (46.1) | 41 (41) | 54 (50.9) | 0.14 |
| Non-atheromatous causes | ||||
| Coronary spasm (%) | 5 (2.4) | 2 (2) | 3 (2.8) | 0.7 |
| SCAD (%) | 5 (2.4) | 1 (1) | 4 (3.8) | 0.2 |
| Thromboembolic (%) | 15 (7.3) | 2 (2) | 13 (12.3) | <0.05 |
| Revascularisation modalities | ||||
| DES (%) | 86 (41.7) | 42 (42) | 44 (41.5) | 0.89 |
| BMS (%) | 94 (45.6) | 53 (53) | 41 (38.7) | 0.08 |
| Glycoprotein IIb/IIIa inhibitors (%) | 14 (6.8) | 3 (3) | 11 (10.4) | <0.05 |
| Manual thrombectomy (%) | 4 (1.9) | 0 (0) | 4 (3.8) | <0.05 |
| No reflow (%) | 7 (3.4) | 4 (4) | 3 (2.8) | 0.63 |
| Stentless strategy (%) | 26 (12.6) | 5 (5) | 21 (19.8) | <0.05 |
| Post-revascularisation TIMI | ||||
| 0 (%) | 5 (2.4) | 3 (3) | 2 (1.9) | 0.15 |
| II (%) | 5 (2.4) | 0 (0) | 5 (4.7) | 0.15 |
| III (%) | 192 (93.2) | 95 (95) | 97 (91.5) | 0.15 |
1 BMS, bare-metal stent; CX, circumflex coronary artery; DES, drugeluting stent; LAD, left anterior descending coronary artery; LMCA, left main coronary artery; PCI, percutaneous coronary intervention; RCA, right coronary artery; SCAD, spontaneous coronary artery dissection; TIMI, thrombolysis in myocardial infarction flow grading system.
Table 4
Pharmacological treatment
| General population (n = 206) | G1 (n = 100) | G2 (n = 106) | p | |
|---|---|---|---|---|
| Ticagrelor (%) | 20 (9.7) | 6 (6) | 14 (13.2) | 0.08 |
| Clopidogrel (%) | 182 (88.3) | 93 (93) | 89 (84) | 0.2 |
| Aspirin (%) | 199 (96.6) | 97(97) | 102 (96.2) | 0.45 |
| B-blockers (%) | 188 (91.3) | 85 (85) | 103 (97.1) | <0.05 |
| ACEi (%) | 163 (79) | 79 (79) | 84 (79.3) | 0.32 |
| ARNi (%) | 1 (0.5) | 0 (0) | 1 (0.9) | 0.33 |
| MRA (%) | 30 (14.6) | 17 (17) | 13 (12.3) | 0.32 |
| Statins (%) | 196 (95.1) | 97 (97) | 99 (93.4) | 0.1 |
| SGLT2i (%) | 39 (19) | 12 (12) | 27 (25.5) | <0.05 |
| DOAC (%) | 3 (1.5) | 0 (0) | 3 (2.8) | 0.09 |
| Acenocoumarol (%) | 11 (5.3) | 5 (5) | 6 (5.7) | 0.85 |
Table 5.
Early adverse events
| General population (n = 206) | G1 (n = 100) | G2 (n = 106) | p | |
|---|---|---|---|---|
| Early CV mortality (%) | 8 (3.9) | 7 (7) | 1 (0.9) | <0.05 |
| Subacute stent thrombosis (%) | 2 (1) | 1 (1) | 1 (0.9) | 0.96 |
| CIN (%) | 4 (1.9) | 3 (3) | 1 (0.9) | 0.28 |
| Mechanical complications (%) | 2 (1) | 1 (1) | 1 (0.9) | 0.97 |
| AF (%) | 9 (4.4) | 5 (5) | 4 (3.8) | 0.68 |
| AHF hospitalisation (%) | 13 (6.3) | 9 (9) | 4 (3.8) | 0.46 |
| Stroke (%) | 3 (1.5) | 3 (3) | 0 (0) | 0.07 |
Table 6
Patients follow-up parameters
| General population (n = 198) | G1 (n = 93) | G2 (n = 105) | p | |
|---|---|---|---|---|
| Angina | ||||
| CCS 2 (%) | 23 (11.6) | 9 (9.7) | 14 (13.3) | 0.8 |
| CCS 3 (%) | 4 (2.0) | 2 (2.2) | 2 (1.9) | 0.8 |
| Dyspnoea | ||||
| NYHA II (%) | 22 (11.1) | 10 (10.8) | 12 (11.4) | 0.29 |
| NYHA III (%) | 5 (2.5) | 4 (4.3) | 1 (1) | 0.29 |
| Smoking cessation (%) | 60 (30.3) | 15 (16.1) | 45 (42.9) | <0.05 |
| Therapeutic adherence (%) | 154 (77.8) | 70 (75.3) | 84 (80) | 0.98 |
| HR (bpm) | 68.9 ± 13.9 | 69 ± 12.9 | 68.8 ± 14.7 | 0.9 |
| SBP (mmHg) | 124.1 ± 21.8 | 124.8 ± 27.2 | 123.4 ± 15.8 | 0.65 |
| LDL-C (g/L) | 0.9 ± 0.3 | 0.8 ± 0.3 | 0.9 ± 0.3 | 0.2 |
| LVEF (%) | 48.7 ± 11.3 | 49 ± 12 | 48.5 ± 10.7 | 0.78 |
| Mean follow-up duration (months) | 38.7 ± 19.3 | 42.4 ± 21.9 | 35.2 ± 15.8 | p < 0.05 |
Table 7
Patients Outcomes.
| General population (n = 206) | G1 (n = 100) | G2 (n = 106) | p | |
|---|---|---|---|---|
| Primary endpoint (%) | 12 (5.8) | 11 (11) | 1 (0.9) | <0.01 |
| Secondary endpoints (%) | 53 (25.7) | 26 (26) | 27 (25.5) | 0.96 |
| Non-fatal MI (%) | 42 (20.4) | 18 (18) | 24 (22.6) | 0.4 |
| AHF hospitalisation (%) | 13 (6.3) | 9 (9) | 4 (3.8) | 0.12 |
| Stent thrombosis/restenosis (%) | 29 (14.1) | 12 (12) | 17 (16.0) | 0.41 |
Figure 2
Survival curves in young and old STEMI patients based on Kaplan-Meier estimates. Younger patients (G2) exhibited significantly higher survival rates compared with older patients (G1) (log-rank p < 0.05). HR, hazard ratio; STEMI, ST-segment elevation myocardial infarction.
Table 8
Logistic regression analysis of factors associated with STEMI in young patients
| Predictor | OR | p | 95% CI |
|---|---|---|---|
| Family history of CAD | 2.85 | 0.034 | 1.08–7.50 |
| Female gender | 0.95 | 0.9 | 0.38–2.38 |
| HTN | 0.77 | 0.45 | 0.39–1.52 |
| DM | 0.69 | 0.24 | 0.37–1.29 |
| Current smoking | 2.58 | 0.016 | 1.19–5.60 |
| CHAU | 4.13 | 0.003 | 1.63–10.5 |
Figure 3
Multivariable Cox survival regression plot. CS, reduced LVEF and age >50 years were independently associated with increased cardiovascular mortality. CI, confidence interval; CS: cardiogenic shock; HR, LVEF, left ventricular ejection fraction; MI: myocardial infarction.