Acute Myocardial Infarction in Young Adults: Prevalence, Clinical Background and In-Hospital Outcomes with Particular Reference to Socio-Economic Influences a Middle Eastern Tertiary Center Experience

Abstract

Background: Acute myocardial infarction in young individuals can cause death and disability in early life and has serious consequences for the patients, their family causing an increased economic burden on health system. Identifying the risk factors for acute myocardial infarction in this group of people is necessary for risk factor modification and developing cost-effective secondary prevention strategies as young. The aim of this study was to determine the prevalence, clinical background and in-hospital outcome of AMI among young (age ≤45 years) adults and its socioeconomic burden. 

Results: All Acute myocardial infarction patients during the period from 2016-2019 were divided into two groups: young adults (age≤45) and older adults (age>45). Age data were available for 3081 patients admitted with acute myocardial infarction. Out of these 593 (19%) patients were young adults with mean age of 39±6.2 whilst 2488 (80.7%) were older adults with mean age of 60±9. Young adult Patients were more of male gender (92% vs 82%, p<0.001) more smoker (47% vs 30 %, p<0.001) and had more prevalence of obesity (BMI ≥30  34% vs 27%, p<0.001) but were less diabetics (43% vs 57%, p<0.001) and less hypertensive (35% vs 58 %, p<0.001).Young adult patients had higher level of LDL (120±47 vs. 112.9±41.6, P=0.02), total cholesterol (189.2±54.4 vs. 173.9±47.7, P<0.001) and triglycerides (157.7±104.4 vs. 126.6±91, P<0.001).Young adult patients had more extensive thrombus and frequently required thrombus aspiration (16 % vs. 11%, p=0.003) but less common left main disease (0.9% vs 4%, p<0.001) and 3 vessels disease (8% vs 18%, p<0.001). Young adult patients had less deterioration of left ventricular function (EF 42.4±10.4 vs.41.1±10.6, P=0.04). There was highly significant negative correlation between left ventricular ejection fraction (LVEF) and age (P<0.001) but positive correlation between age and length of in hospital stay (p=0.02).In-hospital 
complications including pulmonary edema, cardiogenic shock, cardiac arrest and mortality were similar in the two groups. Age, female gender and diabetes were found to be the independent predictors for in-hospital mortality among our patients (P=0.003, 0.05 and 0.05 respectively)
 

Conclusion: Young adult patients presented with acute myocardial infarction are more frequently smokers, obese and dyslipidaemic. These patients also have more thrombus burden. These results underscores the importance of smoking cessation, weight reduction programs and Health education for public especially of this age. Age still showed high risk prediction for lower LVEF and prolonged in-hospital length of stay in AMI patients with more burden on the health care system although the great improvement in management of AMI patients which lead to decrease in hospital complications.