Response by Arora et al to Letter Regarding Article, "Twenty Year Trends and Sex Differences in Young Adults Hospitalized With Acute Myocardial Infarction: The ARIC Community Surveillance Study"

Psychosocial adaptation profiles in young and middle-aged patients with acute myocardial infarction: a latent profile analysis

AIMS

We sought to explore the latent classifications of psychosocial adaptation in young and middle-aged patients with acute myocardial infarction (AMI) and analyse the characteristics of different profiles of AMI patients.

METHODS AND RESULTS

A cross-sectional study was performed in 438 Chinese young and middle-aged patients with AMI. The investigation time was 1 month after discharge. Three different self-report instruments were distributed to the participants, including the Psychosocial Adjustment to Illness Scale, the Perceived Stress Scale, and the Social Support Rating Scale. The seven dimensions of the Psychosocial Adjustment to Illness Scale were then used to perform a latent profile analysis. All participants signed informed consent forms in accordance with the ethical principles of the Declaration of Helsinki. Finally, a total of 411 young and middle-aged AMI patients were enrolled. Three distinct profiles were identified, including the 'well-adapted group' (44.8%), 'highlight in psychological burdens group' (25.5%), and 'poorly adapted group' (29.7%). The influencing factors included stress perception, social support, occupational type, and marital status (P < 0.05).

CONCLUSION

The psychosocial adaptation of young and middle-aged AMI patients can be divided into three profiles. Clinical nurses can carry out individualized psychological interventions according to the characteristics of patients in different potential profiles to improve the psychosocial adaptation of patients and the prognosis of their disease.

Latent profile analysis and related factors of post-traumatic growth in young and middle-aged patients with acute myocardial infarction

BACKGROUND

AMI incidence in young and middle-aged patients is increasing year by year, and such patients are prone to negative emotions after illness, which affects health outcomes. However, post-traumatic growth can bring about positive changes in the patient, which is beneficial to their recovery.

OBJECTIVES

This study aimed to understand the different types of post-traumatic growth characteristics and their related factors in young and middle-aged patients with acute myocardial infarction to help find precise intervention measures.

METHODS

This was a cross-sectional study. Self-reported questionnaires were used to assess general demographic characteristics, post-traumatic growth, and rumination. The mean of the five dimensions of the Post-traumatic Growth Scale was used to perform a Latent profile analysis.

RESULTS

A total of 312 participants, including 285 male and 27 female patients, with the mean age was 51.95±5.75. Latent profile analysis results showed that three-profile model was the most suitable. Three different profiles were named: the "Malgrowth group" (45.51%), the "Good growth group" (18.91%), and the "Excellent growth group" (35.58%). The related factors included rumination, age, monthly income, whether to return to work, marital status, residential address, classification of disease, and whether to perform PCI treatment (P<0.05).

CONCLUSION

According to our results, the post-traumatic growth of young and middle-aged AMI patients can be divided into three profiles, and targeted intervention can be carried out for patients according to the determined patient profiles.

Acute myocardial infarction in the young with diabetes mellitus- national inpatient sample study with sex-based difference in outcomes

BACKGROUND

Mortality after AMI is on the decreasing trend; however, this favorable trend is not observed in the young, especially women. Therefore, we conducted a retrospective analysis using the Nationwide Inpatient Sample (NIS) to identify sex-based outcomes following AMI in young with diabetes.

METHODS

NIS 2010-2014 was used to identify all patients with AMI using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Men (N = 30,950) and women (N = 17,928) patients diagnosed with diabetes were identified and stratified as young if age >18 and <45 years.

RESULTS

Young women with AMI and concomitant diabetes having a higher burden of overall traditional and non-traditional comorbidities. NSTEMI was the major presentation in women as compared to men. Young women with AMI and concomitant diabetes were less likely to receive revascularization with PCI [51.1% vs. 58.2%; OR 0.86, CI 0.78-0.94] or CABG [7.9% vs. 10.1%; OR 0.64, CI 0.54-0.75]. Adjusted all-cause in-hospital mortality did not differ significantly between the two groups [OR 1.06, CI 0.74-1.52]. Women had lower odds of developing cardiogenic shock, ventricular arrhythmias, and AKI, and were more likely to develop major bleeding requiring transfusion, and mitral regurgitation.

CONCLUSION

There were significant differences between young men and women with diabetes in terms of baseline characteristics and clinical presentation, use of revascularization, and cardiac complications, yet overall, in-hospital mortality does not appear to differ. More studies are needed to identify the interaction of sex and diabetes in young AMI population, and areas for practice improvement.

Risk Factors and Outcomes of Very Young Adults Who Experience Myocardial Infarction: The Partners YOUNG-MI Registry

BACKGROUND

Despite significant progress in primary prevention, the rate of myocardial infarction has not decreased in young adults. We sought to compare the risk factor profiles and outcomes between individuals who experienced a first myocardial infarction at a very young (≤40 years) and a young (age 41-50 years) age.

METHODS

We evaluated all patients ≤50 years of age admitted with a Type 1 myocardial infarction to 2 large academic hospitals from 2000 to 2016. Risk factors were determined by review of electronic medical records. The primary outcomes of interest were all-cause and cardiovascular mortality.

RESULTS

Among 2097 consecutive young patients with myocardial infarction, 431 (20.5%) were ≤40 years of age. When compared with their older counterparts, very young patients had similar risk profiles, with the exception of greater substance abuse (17.9% vs 9.3%, P < .001) and less hypertension (37.9% vs 50.9%, P < .001). Spontaneous coronary artery dissection was more prevalent in very young patients (3.1% vs 1.1%, P = .003). Over a median follow-up of 11.2 years, very young myocardial infarction patients had a similar risk of all-cause and cardiovascular mortality.

CONCLUSIONS

Despite being, on average, 10 years younger and having a lower prevalence of hypertension, very young myocardial infarction patients had similar 1-year and long-term outcomes when compared with those aged 41 to 50 years at the time of their index infarction. Our findings suggest the need for aggressive secondary prevention measures in very young patients who experience a myocardial infarction.