Trends In ST-elevation Myocardial Infarction Hospitalisation Among Young Adults: A Binational Analysis.

ABSTRACT

BACKGROUND: ST-segment myocardial infarction (STEMI) is typically associated with increased age, but there is an important group of patients that suffer STEMI under the age of fifty, that are not well characterized in studies. METHODS & RESULTS: We analysed results from Myocardial Ischemia National Audit Project (MINAP) from the United Kingdom (UK) between 2010-2017 and the National Inpatient Sample (NIS) from the United States (US) between 2010-2018. After exclusion criteria, there were 32,719 STEMI patients aged ≤50 from MINAP, and 238,952 patients' ≤50 from the NIS. We analysed temporal trends in demographics, management, and mortality. The proportion of females increased, 15.6% (2010-2012) to 17.6% (2016-2017) (UK) and 22.8% (2010-2012) to 23.1% (2016-2018) (US). The proportion of white patients decreased, from 86.7% (2010) to 79.1% (2017) (UK) and 72.1% (2010) to 67.1% (2017) (US). Invasive coronary angiography (ICA) rates increased in UK (2010-2012 89.0%, 2016-2017 94.3%), while decreased in US (2010-2012 88.9%, 2016-2018 86.2% (US). After adjusting for baseline characteristics and management strategies, there was no difference in all-cause mortality in the UK in 2016-2017 compared to 2010-2012 (OR1.21, 95% CI0.60-2.40), but there was a decrease in the US in 2016-2018 compared to 2010-2012 (OR 0.84, 95% CI 0.79-0.90). CONCLUSION: The demographics of young STEMI patients have temporally changed in the UK and US, with increased proportions of females and ethnic minorities. There was a significant increase in the frequency of diabetes mellitus over the respective time periods in both countries.