Young and Older Patients with Acute Myocardial Infarction: Differences in Risk Factors and Angiographic Characteristics

Marios Sagris; Panagiotis Theofilis; Vasiliki Mistakidou; Evangelos Oikonomou; Konstantinos Tsioufis; Dimitris Tousoulis

doi:10.1016/j.hjc.2024.05.008

Young and Older Patients with Acute Myocardial Infarction: Differences in Risk Factors and Angiographic Characteristics

Hellenic J Cardiol. 2024 May 9:S1109-9666(24)00112-X. doi: 10.1016/j.hjc.2024.05.008. Online ahead of print.

Authors

Marios Sagris¹, Panagiotis Theofilis², Vasiliki Mistakidou³, Evangelos Oikonomou⁴, Konstantinos Tsioufis², Dimitris Tousoulis²

Affiliations

¹ 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece. Electronic address: masagris1919@gmail.com.
² 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece.
³ 3rd Cardiology Department, "Sotiria" Chest Disease Hospital, University of Athens Medical School, Athens, Greece.
⁴ 1st Cardiology Department, "Hippokration" General Hospital, University of Athens Medical School, Athens, Greece; 3rd Cardiology Department, "Sotiria" Chest Disease Hospital, University of Athens Medical School, Athens, Greece.

PMID: 38734305
DOI: 10.1016/j.hjc.2024.05.008

Abstract

Background: Although coronary artery disease mainly affects older individuals, the incidence of myocardial infarction (MI) among younger adults (<55 years) has increased during the past decade. Young and older MI patients have different underlying pathophysiologic characteristics, atherosclerotic plaque morphology, and risk factor profiles.

Methods: We studied 977 patients (≤ 55 years old: 322, > 55 years old: 655) who were hospitalized for MI in the previous 5 years. Patients' baseline characteristics and daily habits were recorded. Angiographic characteristics and vascular lesions were detected, and further examinations, including flow-mediated dilation (FMD), pulse wave velocity (PWV) and central augmentation index (AIx), were performed. Biomarkers of inflammation (Interleukin-6, Tumor-Necrosis factor-a, Intercellular Adhesion Molecule 1, Osteopontin) were also tested.

Results: The median age in the younger age group was 49 years [interquartile range (IQR: 44-53)] and 66 years (IQR): 61-73) in the older age group. Arterial hypertension was less prevalent in the young compared to the elderly with MI (47.4% vs 76.2%, p < 0.01). The younger counterparts presented significantly lower rates of diabetes mellitus (19.3% vs 30.6%, p <0.01), dyslipidemia (59% vs 70.8%, p <0.01), and atrial fibrillation (2.6% vs 9.7%, p <0.01) and were more casual smokers (49.3% vs 23.8%, p <0.01) compared to older patients with MI. In terms of arterial stiffness, lower PWV [7.3 m/s (IQR: 6.5-8.4 m/s) vs. 9 m/s (IQR: 8-10.8 m/s), p <0.01] and AIx (20.5 ± 10.8 vs 25.5 ± 7.8, p <0.01) were recorded in the young compared to the elderly with MI. Concerning angiographic characteristics, younger patients were more likely to have none or single-vessel disease (55.6% vs 45.8%, p < 0.02), whereas the older participants more frequently had three or more vessel disease (23.5% vs. 13.6% in the young, p < 0.02). Although significant disparities in blood test results were detected during the acute phase, the great majority of young MI patients were undertreated.

Conclusion: Younger patients with MI are more likely to be smokers with impaired PWV measures, presenting with non-obstructive or single-vessel disease, while they often remain undertreated. A better knowledge of the risk factors as well as the anatomic and pathophysiologic processes in young adults will help enhance MI prevention and treatment options in this patient population.

Keywords: Angiographic features; Myocardial infarction; Older; Risk factors; Young; arterial stiffness.