Secondary prevention in young patients after acute ST segment elevation myocardial infarction: missing the goals and suffering the penalties

Abstract Introduction Young patients that suffer an acute ST segment elevation myocardial infarction (STEMI) are an especially vulnerable population that requires close monitoring. Therefore, secondary prevention in these pts is key to prevent event recurrence during their lifetime. Purpose To evaluate efficacy of risk factor control in a population of young pts with STEMI. Methods Retrospective, single-center study of consecutive pts, aged below 50 years, admitted with STEMI between 2017 and 2021. Demographics, clinical characteristics and outcomes were analyzed. Parametric and non-parametric tests were performed as appropriate. Results We included 306 pts, 81.7% were men, mean age of 43.9 ± 5.1 years, the majority was admitted with anterior followed by inferior STEMI. Only 26pts were previously under statin therapy, median cLDL at admission was 105±47. At discharge all pts were under statins however only 63% received high intensity statin and 4% ezetimibe. Only 20% of pts completed a cardiac rehabilitation program. During a mean follow-up (FUP) of 3.8 ± 1.7 years, 52.3% of pts had less than optimal controlled hypertension, 20.7% had diabetes, 53% still smoked, cLDL was significantly lower, (mean of 86 ± 39, p<0.001), with a mean reduction of 26.8% ± 46.6. High intensity statin was prescribed to 54% of pts, ezetimibe to 33%, the combination of high intensity statin and ezetimibe to 22%, no one was under iPCSK9 or bempedoic acid. However, only 16.8% of pts met guideline-oriented goal of cLDL<55mg/dl, and only 26.9% presented a 50% reduction from baseline cLDL. In pts with cLDL>55mg/dl only 47.7% were under high intensity statin, 33% under ezetimibe and 30.4% under high intensity statin plus ezetimibe, up titration occurred in about 30% of these pts. When considering pts under high intensity statin and ezetimibe only 23.7% met cLDL goal. During FUP, 19 pts had reinfarction and of these only 5.3% of pts met target cLDL and half were under therapy with high intensity statin and ezetimibe. When considering the 25 pts who died, no one had cLDL<55 nor anyone was under high intensity statin plus ezetimibe. Conclusion Secondary prevention in coronary patients, namely young ones, must be strengthened; cardiac rehabilitation referral and completion of programs has to be optimized and special focus on cardiovascular risk factors control must be made in order to achieve guideline recommended targets and reduce adverse events during follow-up.