Factors associated with adverse outcomes within two years after myocardial infarction in young patients

Aim . To identify independent clinical, laboratory, and instrumental factors associated with the occurrence of a composite endpoint (CEP) within two years in young patients (≤44 years) who have suffered an acute myocardial infarction (AMI). Material and methods . This single-center retrospective study included 331 patients (median age 41 years, 91.5% male) with AMI treated between 2015–2023. Inclusion criteria were: age ≤44 years, confirmed AMI diagnosis, and availability of coronary angiography (CAG). The CEP included recurrent AMI, emergency hospitalisations for cardiovascular reasons, and death during the two-year follow-up period. Patients were divided into a group that reached the CEP (Event, n=30) and a group that did not (Non-Event, n=301). Results . Over the two-year period, the CEP was recorded in 9% of patients. The groups differed significantly in the prevalence of diabetes mellitus/impaired glucose tolerance (46.7% vs. 16.3%; p<0.001), fasting glucose levels (6.8 [5.4; 8.7] vs. 5.7 [5.1; 6.7] mmol/L; p=0.008), systolic blood pressure upon admission (146.5 [130.0; 160.0] vs. 130.0 [120.0; 150.0] mmHg; p=0.034), and left atrial size (4.0 [3.9; 4.2] vs. 3.9 [3.6; 4.1] cm; p=0.007). The number of affected coronary arteries, revascularisation strategy, and traditional risk factors (smoking, dyslipidemia) showed no significant association with the outcome. Multivariate logistic regression analysis identified fasting glucose levels (odds ratio=1.177; 95% confidence interval 1.029-1.346; p=0.017) and left atrial size (odds ratio=4.270; 95% confidence interval 1.459-12.491; p=0.008) as independent factors associated with the risk of CEP. SBP at admission (p=0.082), age (p=0.086) and male sex (p=0.540) did not reach statistical significance in the multivariate model. Conclusion . In young postAMI patients, the risk of adverse twoyear outcomes is determined primarily by fasting glucose levels and left atrial size, rather than by the anatomical extent of atherosclerosis. These findings support a personalised approach to secondary prevention with a focus on glycemic control and assessment of structuralfunctional cardiac parameters.