Abstract 12190: Risk Factor Profiles and Prognostic Factors of Young Japanese Patients with Acute Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention
Background: Young patients with acute myocardial infarction (AMI) have been increasing. The purpose of this study was to clarify the risk factor profiles and the predictors of major cardiovascular events (MACE: a composite of cardiovascular death, MI and stroke) and any coronary revascularizations (ACR) in young AMI patients.
Methods and Results: A total of 5,234 Japanese AMI patients undergoing primary percutaneous coronary intervention (PCI) were identified in the Coronary REvascularization Demonstrating Outcome study in the Kyoto Registry Cohort-2 (CREDO-Kyoto Registry Cohort-2). The patients were divided into the two groups; younger patients (men≤45 years, women≤55 years; n=283, 5.4%) and older patients (men>45 years, women>55 years; n=4951, 94.6%). The coronary risk factors that were more often found in younger patients than in older patients included obesity (body mass index of >25kg/m2; 56.5% vs. 28.5%), current smoker (73.5% vs. 37.4%), high serum triglyceride (≥150mg/dL; 35.0% vs. 16.4%) and high serum low-density lipoprotein-cholesterol (≥140mg/dl; 39.9% vs. 23.5%). Multivariate analysis of possible predictors of MACE indicated that multivessel disease including left main coronary artery lesions (MVD/LMCA; hazard ratio (HR)=2.894, p=0.044) and left ventricular ejection fraction (LVEF) <40% (HR=3.215, p=0.032) were independent predictors of MACE in young AMI patients. With regard to possible predictors of ACR, Killip class 3/4 (HR=3.425, p<0.001), MVD/LMCA (HR=2.434, p<0.001), hemodialysis (HR=5.188, p=0.026), carotid artery stenosis (HR=7.147, p=0.007) and diabetes mellitus treated with medicines (HR=2.632, p<0.001) were identified as independent predictors in young AMI patients by multivariate analysis.
Conclusions: Remarkably high incidences of obesity and current smoker in young Japanese AMI patients suggested the significance of these modifiable risk factors as causal factors of AMI in young patients. During secondary prevention after primary PCI, the severities of index AMI and coronary lesions, rather than modifiable risk factors, were associated with clinical outcomes at 3-year follow-up.
- © 2012 by American Heart Association, Inc.