Perfil clínico e resultados da intervenção coronária percutânea primária em pacientes jovens

Background

The epidemiology of acute myocardial infarction with ST‐segment elevation (STEMI) has been modified in recent years, focusing on young people. Our goal was compare the clinical profile, laboratory, angiographic, and 30‐day clinical outcomes of patients ≤ 40 years with those > 40 years undergoing primary percutaneous coronary intervention (pPCI).

Methods

Prospective cohort study of consecutive patients undergoing pPCI between 2009 and 2011.

Results

A total of 1,055 patients were included, 3.3% of them ≤ 40 years. Young patients were more often black, smokers and with a family history of coronary artery disease, and less often hypertensive and dyslipidemic. In patients ≤ 40 years, leukocyte count and ultrasensitive troponin levels at admission were higher, and high density lipoprotein‐cholesterol, lower. The left anterior descending artery as a culprit vessel and left ventricular ejection fraction did not differ between groups. Although the TIMI 3 flow pre‐intervention was similar, young people showed higher prevalence of myocardial blush 3 pre‐procedure. The door‐to‐balloon time was lower in younger patients (1.0 hour [0.8‐1.4 hour] vs. 1.3 hour [0.9‐1.7 hour]; p = 0.03). At 30 days, patients ≤ 40 years had a mortality of 0% vs. 8.8% for patients > 40 years (p = 0.07).

Conclusions

Patients ≤ 40 years with STEMI and undergoing pPCI show differences in clinical, angiographic and procedural characteristics compared to those > 40 years. In this analysis, representative of the current medical practice, the 30‐day mortality of these patients was very low.