Long-term prognosis of patients having acute myocardial infarction when ≤40 years of age

Data on the long-term prognosis of acute myocardial infarction (AMI) in young patients are limited. This study investigated long-term survival and risk predictors in a series of 108 consecutive patients :540 years old who represented 4% of 2,644 patients who presented with AMI at a single center between June 1986 and April 1992. Four patients died soon after admission. The overall mortality rate of the 104 survivors was 25.5% at 15 years. The mortality rate was higher in patients who had type 1 diabetes mellitus (p = 0.01), long-term excessive alcohol intake (p = 0.035), peripheral arterial disease (p = 0.004), previous AMI (P = 0.04), anterior AMI (p 0.01), and depressed left ventricular ejection fraction (p < 0.0001). Cumulative survival rates (Kaplan-Meier analysis) at 1, 5, 10, and 15 years were 99%, 95%, 86%, and 75%, respectively. Event-free survival rates (death, AMI, coronary intervention, severe angina pectoris, malignant arrhythmias, and congestive heart failure) at the same times were 88%, 76%, 60%, and 43%, respectively. The strongest independent predictors of the long-term mortality rate were ejection fraction less than or equal to 45% (odds ratio 4.4, 95% confidence interval 1.6 to 12.4, p < 0.001) and peripheral arterial disease (odds ratio 45.9, 95% confidence interval 3.79 to 555, p < 0.0001). These data suggest that the long-term prognosis and functional status of young patients who have AMI are not benign, especially when ejection fraction is decreased or peripheral atherosclerotic disease is present. (C) 2004 by Excerpta Medica, Inc.