TERRITORIAL IMPACT ON CLINICAL OUTCOMES IN YOUNG POPULATION WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Abstract

Objective: ST-segment elevation myocardial infarction (STEMI) at younger age though infrequent but very crucial entity, but there is dearth of available data, however, a rising trend has noticed recently in Asian countries. The aim was to see the territorial and clinical profile influence on overall outcomes of young individuals (≤35 years) with STEMI.

Methodology: Patients with STEMI having age of ≤35 years during August 2020 to December 2020 were recruited and divided into left anterior descending artery (LAD)-culprit and non-LAD-culprit STEMI groups in this prospective observational study. Territorial angiographic and clinical characteristics were compared.

Results: 1435 STEMI patients underwent coronary angiogram, 5.3% (94) were ≤35 years of age. LAD was culprit in 74.4% of STEMI mainly as a single vessel disease (SVD) involving the proximal segment as major territorial angiographic finding while 25.5% were non-LAD-culprit STEMI.  Obesity, smoking, smokeless tobacco use especially gutka, were frequent in LAD-culprit group. In-hospital and at 3 months mortality was 2.1% (2) and 7.1% (5) respectively, all related to LAD territory. Rate of safe discharges and back to routine was 97.2% vs.100% and 70% vs.79.1% (72), respectively were comparable in both groups.

Conclusion: LAD predominantly its proximal segment is the commonest culprit territory in patients with STEMI in youth with significant association to obesity, smoking and smokeless tobacco use especially gutka. LAD-culprit STEMI is the major territorial determinant for mortality and heart failure, however, overall clinical outcomes were reasonably good and comparable with non-LAD-culprit STEMI considering alive discharges and back to routine life.