Findings from the Italian Genetic Study on Early-onset Myocardial Infarction (MI) suggest various baseline factors ranging from gender to baseline ejection fraction may be useful in predicting the future risk of recurrent ischemic events. The findings were presented Aug. 31 at ESC Congress 2019 and published as a research letter in the Journal of the American College of Cardiology.

The study involved 2,000 patients (1,778 men, 222 women) under the age of 45 (median age, 41) who experienced a type 1 MI and underwent coronary angiography. A standardized case report form was used at intake that included detailed information about family history of cardiovascular diseases, cardiovascular risk factors, lifestyles and medications. Patients were followed for a median of 19.9 years using scheduled outpatient visits and standardized telephone contacts. The primary endpoint was the composite of cardiovascular death, nonfatal MI or nonfatal ischemic stroke.

According to Diego Ardissino, MD, FACC, and colleagues, a primary endpoint was experienced by 714 patients (36 percent) in the study. Of these, 153 died of cardiovascular causes, 479 experienced recurrent nonfatal MI and 82 had an acute ischemic stroke. Deaths for all causes occurred in 258 patients. More than one primary endpoint was experienced by 136 patients.

Multiple logistic regression identified baseline ejection fraction, hypertension, baseline Duke Coronary Score Index, being male, hypercholesterolemia, and a previous arterial or venous thromboembolic event as six variables independently associated with the risk of major adverse cardiovascular events during follow-up.

"Our descriptive and exploratory data concerning the patterns of MACE in patients experiencing a MI before the age of 45 years help characterize the prognosis of this patient group," Ardissino, et al., note. "… Future studies addressing the impact of early aggressive treatments in this highly selected, high-risk patient population are required in order to establish the clinical impact of risk characterisation on long-term recurrence outcomes."

Clinical Topics: Cardiovascular Care Team, Diabetes and Cardiometabolic Disease, Dyslipidemia, Prevention, Lipid Metabolism, Nonstatins

Keywords: ESC 19, ESC Congress, Ischemia, Myocardial Infarction, Cholesterol, Dyslipidemias, Primary Prevention

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