Young Adults Undergoing Percutaneous Coronary Intervention for Myocardial Infarction in the United States, 2011 to 2023.

Abstract

The prognostic impact of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in young adults undergoing percutaneous coronary intervention (PCI) remains under explored. We compared the long-term outcomes of young adults undergoing PCI for STEMI and NSTEMI. We used the United States (US) TriNetX database (2011 to 2023), encompassing young adults aged 18 to 50 years hospitalized for myocardial infarction (MI), who received PCI within 24 hours of presentation. We used 1:1 propensity score matching to adjust for baseline differences; cardiovascular outcomes were assessed at 5 years using Cox proportional hazards models. Of 16,209 patients, 53% presented with STEMI and 47% with NSTEMI. After matching, 9,680 patients were analyzed (4,840 in each group). At 5 years, patient with STEMI exhibited higher risk of all-cause mortality [hazard ratio (HR), 1.21 (95% confidence interval, 1.04 to 1.39)], and heart failure (HF) [1.25 (1.12 to 1.41)] compared with those with NSTEMI. There were no significant differences between groups for MI (HR: 0.85 [0.66 to 1.08]), stroke (HR: 1.12 [0.94 to 1.34]), major bleeding (HR: 1.15 [0.99 to 1.29]) and renal replacement therapy (0.1 vs 0.1 per 100 person-years; HR: 0.77 [0.46 to 1.29]). In conclusion, young adults with STEMI undergoing PCI had a higher risk of mortality and HF compared with those with NSTEMI at 5 years. These findings underscore the importance of early and aggressive intervention to mitigate long-term cardiovascular risks in this population.