| Abstract |
Introduction. It has been observed that acute myocardial infarction (AMI), which is one of the most frequent causes of death worldwide, is beginning to affect younger ages. The shift of this specific pathology to younger ages (<45 years) is a modern public health issue and has serious implications for the health system and the society in general. In addition to mortality, the presence of AMI also affects indicators such as the need for hospitalization, "lost" work-days, the quality of life of patients, etc., all important factors when referring especially to young people.
Purpose. The purpose of the present study is to investigate risk factors associated with the onset of AMI, to study treatment options and their association with patient outcome, and to assess the predictive ability of risk factors on patient outcome.
Methodology: This is a single center retrospective study at the Cardiology Clinic of Heraklion University Hospital. Data were collected from the physical record of patients hospitalized in the clinic with a diagnosis for AMI and who met the criteria, under 55 years old in the period 2018-2023. Demographics, daily habits, individual and family medical history and cardiac imaging results were recorded. Analyses were performed in the total populations and at age groups <45 and between 45-55 were also performed. Data were statistically analyzed with the IBM SPSS Statistics 24.0 software.
Results: A sample of 161 patients was analyzed. The mean age was 46.9 ± 6.6 years with a minimum of 20 years. About 1 in 4 (24.5%) were unemployed. The most frequently recorded risk factors included smoking (84.5%), hyperlipidemia (72.7%), and metabolic syndrome (70.2%). Among age groups <45 and 45-55, older adults had higher rates of hyperlipidemia (p=0.01), while younger adults had more frequent substance and alcohol abuse (p=0.05). Mean body weight (in Kg) and BMI differed significantly between the age groups. (BS Group <45 years 117 kg vs Group >45-55 years 87 kg p=0.05) and Group <45 years BMI 32.1 Kg/m2 vs Group >45-55 years 28.9 Kg/m2, p=0.003). Patients experienced chest pain (100%) while 97% had prodromal symptoms and 66% had sweating at presentation.
In the majority of cases, the health service that received the patients was the ED of the public hospitals of Crete (N=106, 65.8%). Delayed (>12 hours) arrival occurred in 20 (12.4%) patients, with mean hours of delayed arrival 26.33 hours (min 12 hours - max 96 hours).These patients had a lower ejection fraction on admission (p<0.001), but without an impact on the final outcome. Syncope was more frequent in those patients aged <45 years (p=0.003). The type of AMI (with/without ST elevation) not related to age, sex, or any other factor. All patients underwent coronary angiography. Single vessel disease was found in 59%, while the number of vessels with significant stenoses was associated and was higher in males (p=0.042). The laboratory values followed an increasing course from admission to the day of exacerbation, and then recovered to near normal on the day of discharge (p<0.001). Angioplasty was applied in 89.4% (N=144) (early in 69.6%), stent placement in 88.8%. Thrombolysis was performed in 14 patients, of which 13 later underwent angioplasty. The mean length of stay in the Cardiac Unit (CCU) was 3.6 ± 2.0 days, in the hospital was 8.5 ± 5.6 days, and differed between age groups (Group <45 years 10.3 days vs Group > 45-55 years 7.5 days, p=0.05).100% of the patients survived to discharge without severe complications.
Conclusions. AMI episodes at ages below 55 years are not rare. The most frequent risk factors were smoking, hyperlipidemia and metabolic syndrome. Younger age groups <45 years had a higher BMI, more frequent, more frequent drug and alcohol abuse, more severe initial symptoms and complications and a 3-day longer length of stay in ICU and in the hospital. Importantly, there were no fatal events in the five-years recorded cases and the outcome was satisfactory regardless of age. The work is the first official record of the cases of AMI in young individuals in Crete.
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