Clinical profile and outcomes of young patients with ST-elevation myocardial infarction
A R Costa, M Moreira, I Gomes Campos, J L Ferraro, I Bastos Castro, C Almeida, R Pontes Dos Santos, J Ponte Monteiro, L Reis, A AndradeAbstract
Background
ST-elevation myocardial infarction (STEMI) is a major global cause of morbidity and mortality. Although it predominantly affects older adults, its incidence is rising in younger populations. Understanding this group profile may help guide prevention and optimize management strategies.
Purpose
To evaluate the clinical profile and outcomes of young patients with STEMI.
Methods
Retrospective, single-center observational study conducted at a tertiary hospital from September 2023 to September 2025, including all patients aged ≤50 admitted with STEMI.
Results
Among 273 patients admitted with suspected STEMI, 50 (18.3%) were aged ≤50 years. STEMI was subsequently confirmed in 45 of these patients. Atherothrombotic disease accounted for 88.9% of cases, while coronary dissection and MINOCA were observed in 6,6% and 4.4% of patients, respectively. Patients were predominantly male (88.9%) with a mean age of 43.6 ± 6.5 years and exhibited a high burden of cardiovascular (CV) risk factors, including diabetes (15.6%), dyslipidemia (51.1%), hypertension (46.7%) and active or former smoking in 80.0%. Excess body weight was frequent (38.6% overweight and 31.8% obese) and 11.1% reported a family history of premature myocardial infarction. Chest pain was the presenting symptom in 97.8% of cases, and most patients (91.1%) were triaged through coronary fast-track protocol. Median ECG-to-catheterization and door-to-catheterization times were 76.5 and 55.5 minutes, respectively, with a median total ischemic time of 245 minutes. Percutaneous coronary intervention was performed in 75.6%, and single-vessel disease predominated (72.1%), with preserved left ventricular ejection fraction in 72.7% of patients on initial echocardiography. Metabolic profiling revealed an early yet notable cardiometabolic burden in these young patients: glycemic control was generally preserved (median HbA1c of 5.6%), while lipid parameters revealed atherogenic dyslipidemia with elevated LDL (mean of 125.7 ± 37.0 mg/dL) and a mean total cholesterol averaged 199.5 ± 39.5 mg/dL. Despite this profile, only 26.7% of patients were receiving lipid-lowering therapy prior to admission. No in-hospital deaths occurred.
Conclusions
Atherothrombosis is the leading cause of STEMI in young adults, whose CV risk profiles mirror those of older populations, highlighting the central role of traditional risk factors even at early ages. Although in-hospital reperfusion was timely, total ischemic time remained prolonged, reinforcing the need for earlier and more aggressive preventive strategies.