AMI Mortality Increasing Among Young Adults With Nontraditional Risk Factors, With Mohan Satish, MD

In-hospital mortality has been drastically increasing among young adults with first acute myocardial infarction (AMI) between 2011 and 2022, particularly among young women, and is associated with more nontraditional risk factors than traditional.1

Although mortality from AMI in the US has declined overall in the 2010s, this has largely been driven by older adults and men. Additionally, the prevalence of several modifiable, traditional risk factors is increasing among young adults hospitalized with AMI, with significant sex differences. Many investigators have determined that these parallel trends demand further examination of sex differences and nontraditional risk factors among young adults.2

“Our current risk paradigms for understanding somebody’s risk in 10 years and 30 years are very much grounded upon somebody’s traditional risk,” Mohan Satish, MD, a cardiology fellow at NYP-Weill Cornell and lead author of this study, told HCPLive in an exclusive interview. “What is your blood pressure? What is your cholesterol? We talk about knowing somebody’s numbers, and not so much these non-traditional risk elements. It’s going to take a 2-pronged effort, both from the physician and the patient, to understand these non-traditional risk elements that we’re dealing with and how we can incorporate them to understand somebody’s real risk.”

Satish and colleagues sourced data from the National Inpatient Sample (NIS), examining hospitalizations for first AMI. Patients were included if they were between 18 and 54 years old, excluding those ≥55 years to maintain consistency with existing definitions of “young adults.” Additionally, all hospitalizations with missing data or 0-day length of stay from primary analyses were excluded.2

Patient demographics, including age, biological sex, race, ethnicity, and quartile of median household income, were extracted – the lowest household income quartile was included as a nontraditional risk factor. Traditional risk factors included obesity, hypertension, diabetes, tobacco use, and dyslipidemia, while nontraditional factors included metabolic syndrome, chronic kidney disease, family history of ischemic heart disease, obstructive sleep apnea, hypothyroidism, and others.2

The primary outcome for this study was all-cause in-hospital mortality. The team assessed annual in-hospital mortality trends and the incidence of in-hospital complications, including cardiogenic shock, cardiac tamponade, acute stroke, cardiac arrest, major bleed, and others. In parallel, receipt of coronary angiography or coronary revascularization, as well as the receipt of mechanical circulatory support during the index first AMI hospitalization, were analyzed.2

From 2011 to 2022, roughly 945,977 hospitalizations in the US had a principal discharge diagnosis of first AMI in young adults, of which 356,115 were STEMI (37.6%), and 589,862 were NSTEMI (62.4%). A higher proportion of STEMI hospitalizations were men compared with women (77.2%), and the lowest income quartile was the most common nontraditional risk factor in STEMI, with a significantly higher prevalence in women (34.9% vs 28.7%; P <.001). First NSTEMI hospitalizations were also higher in men (66.2%), and the lowest income quartile was again the most prevalent nontraditional factor in hospitalizations, with a higher prevalence among women (38.1% vs 32.3%; P <.001).2

From 2011 to 2022, Satish and colleagues saw a substantial increase in unadjusted in-hospital mortality for first STEMI (2.1% to 3.3%, 1.2% absolute increase; P for trend <.001). However, it was unchanged for first NSTEMI (0.2% absolute decrease, P for trend = .7). Overall, women had a higher in-hospital mortality rate compared with young men in both STEMI (3.1% vs 2.6%; P <.001) and NSTEMI (1% vs 0.8%; P = .03) and saw similar in-hospital complications. However, women also saw significantly lower receipt of cardiovascular procedures.2

Ultimately, although in-hospital mortality for both AMI subtypes substantially increased across all subtypes among young adults between 2011 and 2022, mortality for both STEMI and NSTEMI was higher in young women and was associated with nontraditional risk factors. Satish and colleagues determined that further investigation into increasing first STEMI mortality is needed, particularly into sex-based disparities and the prevalence of nontraditional risk factors.2

“There are attempts to start to understand risk from a sex-based standpoint,” Satish said. “When somebody hits the hospital, we’re trying to refine our risk models in a sex-based way. There’s been good predictor performance – the idea now is, how do we actually implement that? How do we make providers accountable for using these risk tools? We’re starting to potentially try to implement that.”

Editors’ Note: Satish reports no relevant disclosures.

References

1. American Heart Association. Heart attack deaths rose between 2011 and 2022 among adults younger than age 55. Eurekalert. February 26, 2026. Accessed March 10, 2026. https://www.eurekalert.org/news-releases/1117257

2. Satish M, Walters RW, Wenzl FA, Safford M, Kini V. Sex differences in outcomes of young adults hospitalized with first myocardial infarction from 2011 to 2022. Journal of the American Heart Association. 2026;15(5). doi:10.1161/jaha.125.046517