title: Long-term outcome and risk assessment in premature acute myocardial infarction: A 10-year follow-up study.
abstract: BACKGROUND
  Premature acute myocardial infarction (AMI) is a rare disease carrying significant morbidity and mortality. Existing data on outcome in these patients is based on retrospective analysis of angiographic reports or refer to time periods with incomparable treatment regimes, making them unusable for risk assessment in times of widespread use of reperfusion therapy. Aim of this study was to assess the outcome of premature AMI in a prospectively recruited study population enrolled in the times of modern reperfusion therapy.
  
  
  METHODS
  We included 102 consecutive AMI survivors (≤40years) in this prospective multicentre study. Outcome was assessed via retrieval query of the Austrian Death Registry and the centralized patient management system of Vienna.
  
  
  RESULTS
  During a median follow up time of 10.3years (IQR:8.9-11.1), 23% of all patients experienced MACE, of those 6% died, 17% experienced re-AMI and 5% patients an ischemic stroke. Furthermore, forty patients underwent cardiac re-catheterization and twenty-five needed recurrent revascularization. MACE were associated among the classic cardiovascular risk factors with elevated levels of HbA1c (adj. HR 1.32; 95%CI 1.06-1.64; P=0.012), total cholesterol (adj. HR 2.16; 95%CI 1.27-3.48; P=0.004), and c-reactive protein (adj. HR 1.67; 95%CI 1.29-2.17; P=0-003) for an increase of 1-standard deviation.
  
  
  CONCLUSIONS
  Although myocardial re-infarction was the driving force of morbidity in premature myocardial infarction, we observed an excellent long-term survival opposed to previous reports. We found that persistence risk factors rather than the clinical risk profile at baseline influences the outcome in these patients, emphasizing the importance of secondary prevention in young patients after AMI.
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Max-Paul
authors.initials: MP
authors.lastname: Winter
authors.affiliation: Linz General Hospital, Johannes Kepler University School of Medicine, Department of Internal Medicine I - Cardiology, Linz, Austria.
authors.forename: Hermann
authors.initials: H
authors.lastname: Blessberger
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Arman
authors.initials: A
authors.lastname: Alimohammadi
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Noemi
authors.initials: N
authors.lastname: Pavo
authors.affiliation: Third Medical Department, Cardiology and Intensive Care Medicine, Wilhelminen Hospital, Vienna, Austria.
authors.forename: Kurt
authors.initials: K
authors.lastname: Huber
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria; Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria; Core Facilities, Medical University of Vienna, Vienna, Austria.
authors.forename: Johann
authors.initials: J
authors.lastname: Wojta
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lang
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.
authors.forename: Franz
authors.initials: F
authors.lastname: Wiesbauer
authors.affiliation: Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria. Electronic address: georg.goliasch@meduniwien.ac.at.
authors.forename: Georg
authors.initials: G
authors.lastname: Goliasch
mesh_terms: D000328:Adult; D015415:Biomarkers / Q000097:blood; D006328:Cardiac Catheterization / Q000401:mortality / Q000639:trends*; D016022:Case-Control Studies; D002423:Cause of Death / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000401:mortality / Q000628:therapy*; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D015415:Biomarkers
keywords: ACS; AMI; Premature CAD; Prognosis