Author + information
- Received January 15, 2020
- Revision received March 10, 2020
- Accepted March 16, 2020
- Published online June 1, 2020.
- Wanda Y. Wu, BAa,b,
- David W. Biery, ABa,
- Avinainder Singh, MBBS, MMScc,
- Sanjay Divakaran, MDa,
- Adam N. Berman, MDa,
- Gloria Ayuba, DOa,
- Ersilia M. DeFilippis, MDd,
- Khurram Nasir, MD, MPHe,
- James L. Januzzi, MDf,
- Marcelo F. Di Carli, MDa,g,
- Deepak L. Bhatt, MD, MPHa@DLBHATTMD and
- Ron Blankstein, MDa,g,∗ (, )@RonBlankstein@JJheart_doc
- aCardiovascular Division, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- bBoston University School of Medicine, Boston, Massachusetts
- cYale University School of Medicine, New Haven, Connecticut
- dNewYork-Presbyterian/Columbia University Irving Medical Center, New York, New York
- eHouston Methodist Hospital, Houston, Texas
- fCardiology Division, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- gDepartment of Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Address for correspondence:
Dr. Ron Blankstein, Brigham & Women’s Hospital, 75 Francis Street, Boston, Massachusetts 02115.
Background Left ventricular ejection fraction (EF) recovery is associated with better long-term outcomes after myocardial infarction (MI). However, the association between long-term outcomes and EF recovery among young MI patients has not been investigated.
Objectives This study sought to evaluate the prevalence of left ventricular systolic dysfunction among patients who experience their first MI at a young age and to compare outcomes between those who recovered their EF versus those who did not.
Methods The YOUNG-MI registry is a retrospective cohort study of patients who experienced an MI at ≤50 years of age. EF at the time of MI and within 180 days post-MI were determined from all available medical records. The primary outcomes were all-cause and cardiovascular mortality.
Results There were 1,724 patients with baseline EF data: 503 (29%) had EF <50%, whereas 1,221 (71%) had a normal baseline EF. Patients with lower EF were more likely to have experienced ST-segment elevation MI, have higher troponin values, and have more severe angiographic coronary artery disease. Among patients with abnormal baseline EF, information on follow-up EF was available for 216, of whom 90 (42%) recovered their EF to ≥50%. Patients who experienced EF recovery had less severe angiographic disease, lower alcohol use, and a lower burden of comorbidities. Over a median follow-up of 11.1 years, EF recovery was associated with an ∼8-fold reduction in all-cause mortality (adjusted hazard ratio: 0.12; p = 0.001) and a ∼10-fold reduction in cardiovascular mortality (adjusted hazard ratio: 0.10; p = 0.025).
Conclusions Nearly one-third of young patients presented with left ventricular dysfunction post-MI. Among them, EF recovery occurred in more than 40% and was independently associated with a substantial decrease in all-cause and cardiovascular mortality.
Drs. Berman and Divakaran are supported by a T32 postdoctoral training grant from the National Heart, Lung, and Blood Institute (T32 HL094301). Dr. Januzzi is supported in part by the Hutter Family Professorship. Dr. Januzzi is a Trustee of the American College of Cardiology; has served as a board member for Imbria Pharmaceuticals; has received grant support from Novartis Pharmaceuticals, Roche Diagnostics, Abbott, Singulex, and Prevencio; has received consulting income from Abbott, Janssen, Novartis, Pfizer, Merck, and Roche Diagnostics; and has participated in Clinical Endpoint Committees/Data Safety Monitoring Boards for Abbott, AbbVie, Amgen, Boehringer Ingelheim, Janssen, and Takeda. Dr. Di Carli has received institutional research grant support from Gilead Sciences and Spectrum Dynamics; and has received consulting honoraria from Bayer and Janssen. Dr. Bhatt has served on the Advisory Board for Cardax, Cereno Scientific, Elsevier Practice Update Cardiology, Medscape Cardiology, PhaseBio, PLX Pharma, and Regado Biosciences; has served on the Board of Directors for the Boston VA Research Institute, Society of Cardiovascular Patient Care, and TobeSoft; has served as the Chair of American Heart Association Quality Oversight Committee, NCDR-ACTION Registry Steering Committee, and VA CART Research and Publications Committee; has served on the Data Monitoring Committee for the Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; for the PORTICO trial, funded by St. Jude Medical, now Abbott), Cleveland Clinic (including for the ExCEED trial; funded by Edwards), Duke Clinical Research Institute, Mayo Clinic, Mount Sinai School of Medicine (for the ENVISAGE trial; funded by Daiichi-Sankyo), and Population Health Research Institute; has received honoraria from the American College of Cardiology (Senior Associate Editor, Clinical Trials and News, ACC.org; Vice-Chair, ACC Accreditation Committee), Baim Institute for Clinical Research (formerly Harvard Clinical Research Institute; RE-DUAL PCI clinical trial steering committee, funded by Boehringer Ingelheim; AEGIS-II executive committee, funded by CSL Behring), Belvoir Publications (Editor-in-Chief, Harvard Heart Letter), Duke Clinical Research Institute (clinical trial steering committees, including for the PRONOUNCE trial, funded by Ferring Pharmaceuticals), HMP Global (Editor-in-Chief, Journal of Invasive Cardiology), Journal of the American College of Cardiology (Guest Editor; Associate Editor), Medtelligence/ReachMD (CME steering committees), Population Health Research Institute (for the COMPASS operations committee, publications committee, steering committee, and USA national co-leader, funded by Bayer), Slack Publications (Chief Medical Editor, Cardiology Today’s Intervention), Society of Cardiovascular Patient Care (Secretary/Treasurer), and WebMD (CME steering committees); has served as the Deputy Editor for Clinical Cardiology; has received research funding from Abbott, Afimmune, Amarin, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Cardax, Chiesi, CSL Behring, Eisai, Ethicon, Ferring Pharmaceuticals, Forest Laboratories, Fractyl, Idorsia, Ironwood, Ischemix, Lexicon, Lilly, Medtronic, Pfizer, PhaseBio, PLx Pharma, Regeneron, Roche, Sanofi, Synaptic, and The Medicines Company; has received royalties from Elsevier (Editor, Cardiovascular Intervention: A Companion to Braunwald’s Heart Disease); has served as a site co-investigator for Biotronik, Boston Scientific, CSI, St. Jude Medical (now Abbott), and Svelte; has been a trustee of the American College of Cardiology; and has conducted unfunded research for FlowCo, Merck, Novo Nordisk, and Takeda. Dr. Blankstein has received research support from Astellas and Amgen. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Kim Eagle, MD, served as Guest Editor for this paper. P.K. Shah, MD, served as Guest Editor-in-Chief for this paper.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC author instructions page.
- Received January 15, 2020.
- Revision received March 10, 2020.
- Accepted March 16, 2020.
- 2020 American College of Cardiology Foundation
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