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

摘要

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.