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Cho, Jeong, Ahn, Chae, Seong, Kim, Yoon, Rhew, Chae, Chae, Lee, Hwang, Cho, Kim, Kim, Chung, Rha, Jang, Seung, Park, and Other Korea Acute Myocardial Infarction Registry Investigators: Predictive Factors of Major Adverse Cardiac Events and Clinical Outcomes of Acute Myocardial Infarction in Young Korean Patients
Original Article
Korean Circulation Journal

Korean Circulation Journal 2008; 38(3): 161-169.

Published online: 31 March 2008

DOI: https://doi.org/10.4070/kcj.2008.38.3.161

Predictive Factors of Major Adverse Cardiac Events and Clinical Outcomes of Acute Myocardial Infarction in Young Korean Patients

Jae Yeong Cho, MD, Myung Ho Jeong, MD, Youngkeun Ahn, MD, Shung Chull Chae, MD, In Hwan Seong, MD, Young Jo Kim, MD, Junghan Yoon, MD, Jay Young Rhew, MD, Jei Keon Chae, MD, In Ho Chae, MD, Nae Hee Lee, MD, Jin Yong Hwang, MD, Myeong Chan Cho, MD, Kee Sik Kim, MD, Chong Jin Kim, MD, Wook Sung Chung, MD, Seung Woon Rha, MD, Yang Soo Jang, MD, Ki Bae Seung, MD, Seung Jung Park, MD; Other Korea Acute Myocardial Infarction Registry Investigators

Korea Acute Myocardial Infarction Registry of the Korean Society of Cardiology, Gwangju, Korea.

Correspondence: Myung Ho Jeong, MD, The Heart Center of Chonnam National University Hospital, 8 Hak-dong, Dong-gu, Gwangju 501-757, Korea. Tel: 82-62-220-6243, Fax: 82-62-228-7174, myungho@chollian.net

Received 18 October 2007       Accepted 3 December 2007

Copyright © 2008 The Korean Society of Cardiology

Abstract

Background and Objectives

Acute myocardial infarction (AMI) occurring in patients at a young age (40 years or younger) is an uncommon condition and is characterized by multiple cardiovascular risk factors. We analyzed the risk factors of young-aged Korean AMI patients (age of 40 years or younger) and other AMI patients, who were registered in the Korea Acute Myocardial Infarction Registry (KAMIR) for one year.

Subjects and Methods

In 2006, 8,565 patients (mean age 64.4±12.7 years; 5,591 males) were registered in the KAMIR. The patients were divided into two groups: Group I (younger patients ≤40 years; n=261; mean age 35.9±4.5 years; 245 males) and Group II (older patients >40 years; n=8,304, mean age 65.4±11.8 years; 5,330 males). The clinical and angiographic characteristics and major adverse cardiac events (MACE) were compared for the two groups of patients.

Results

The baseline clinical characteristics of gender, age, risk factors (hypertension, smoking, diabetes, familial history) and body weight were different between the two groups (p<0.001). The baseline echocardiographic and laboratory findings of the initial ejection fraction, and the glomerular filtration rate, level of creatine kinase (CK), level of CK-MB isoenzyme, total cholesterol level, triglyceride level, and N-terminal prohormone brain natriuretic peptide (NT-proBNP) level were different between the two groups (p≤0.001). According to the use of multiple logistic regression analysis, use of thrombolysis [p=0.009, adjusted hazard ratio (aHR)=9.140, 95% confidence interval (CI): 1.727-48.383], a high blood glucose level (p=0.029, aHR=1.008, 95% CI: 1.001-1.016), a low body mass index (<25 kg/m2, p=0.031, aHR=6.236, 95% CI: 1.183-32.857), and a high CK-MB level and high Thrombolysis in Myocardial Infarction (TIMI) risk score were independent predictors of MACE at 1 year after an AMI in young age patients. Early clinical outcomes were better in Group I than in Group II patients, but one-, six-and twelve-month MACE were not different between the two groups.

Conclusion

The independent predictors of MACE at 1 year in young age AMI patients were the use of thrombolysis, a high blood glucose level, a low body mass index, a high CK-MB level and a high TIMI risk score. Patients that have had an acute myocardial infarction at a young age have a better early clinical outcome, but the long-term clinical outcomes were not different compared with older patients, and thus long-term intensive medical therapy will be required, even in young AMI patients.

Keywords: Myocardial infarction, Age of onset, Prognosis

Figures and Tables

Fig. 1
MACE-free survival during one-year follow-up. It was not different between the young and old aged patients [age≤40 (Group I) and age >40 (Group II)] (p<0.136 by the log-rank test). MACE: major adverse cardiac events.
kcj-38-161-g001
Table 1
Baseline clinical characteristics
kcj-38-161-i001

TIMI: thrombolysis in myocardial infarction

Table 2
Comparison of initial laboratory findings
kcj-38-161-i002

hsCRP: high sensitivity C-reactive protein, HDL: high density lipoprotein, LDL: low density lipoprotein, BNP: brain natriuretic peptide, NT-proBNP: N-terminal prohormone brain natriuretic peptide

Table 3
Comparison of previous and post-myocardial infarction medications between two groups
kcj-38-161-i003
Table 4
Comparison of ECG presentations between two groups
kcj-38-161-i004

ECG: electrocardiogram

Table 5
Independent predictors of major adverse cardiac events at one-year follow-up in the young age acute myocardial infarction
kcj-38-161-i005

CI: confidence interval, TIMI: thrombolysis in myocardial infarction

Table 6
Comparison of coronary angiographic findings
kcj-38-161-i006

TIMI: thrombolysis in myocardial infarction, ACC/AHA: American College of Cardiology/American Heart Association, PCI: percutaneous coronary intervention, DES: drug-eluting stent

Table 7
Comparison of early clinical outcomes and MACE
kcj-38-161-i007

MACE: major adverse cardiac events

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