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Original research
Prevention and treatment of premature ischaemic heart disease with European Society of Cardiology Guidelines
  1. Michel Zeitouni,
  2. David Sulman,
  3. Johanne Silvain,
  4. Mathieu Kerneis,
  5. Paul Guedeney,
  6. Olivier Barthelemy,
  7. Delphine Brugier,
  8. Pierre Sabouret,
  9. Niki Procopi,
  10. Jean-Philippe Collet,
  11. Gilles Montalescot
  1. Department of Cardiologie, Sorbonne University – Paris 06 (UPMC), ACTION Study Group, INSERM UMRS 1166, Cardiology Institute, Pitié-Salpêtrière (AP-HP) University Hospital, Paris, France
  1. Correspondence to Professor Gilles Montalescot, Institut de Cardiologie, Pitié Salpêtrière University Hospital Department of Cardiology, 75013 Paris, Île-de-France, France; gilles.montalescot{at}


Objective To determine if the changes in the European Society Cardiology/European Atherosclerotic Society (ESC/EAS) guidelines improved the identification for primary prevention therapy in young adults at risk of a premature myocardial infarction.

Methods Patients admitted for a first ST-segment elevation myocardial infarction (STEMI) in the ePARIS registry (n=2757) between 2010 and 2018 were classified by age: <55, 55–65 and >65 years old. Using Systematic Coronary Risk Estimation 2, we evaluated whether patients would have been detected and treated with primary prevention statins before their first STEMI based on the 2021 EAS/ESC guidelines versus 2019 and 2016 guidelines. Eligibility for intensive proprotein convertase subtilisin/kexin type 9 (PCSK9i) in secondary prevention was also assessed.

Results Following 2021 ESC guidelines, 62.5% of individuals aged <55 years old would have been eligible for statins before their first STEMI, similarly to older age categories. In comparison, only 17% and 18% of young individuals would have been eligible for primary prevention statins prior to their first STEMI with 2016 and 2019 guidelines, compared with group 55–65 years (41% and 35%) and >65 years old (19% and 72%), p<0.01. After their first STEMI, 25% of patients <55 years would be eligible for PCSK9i, compared with 23.2% and 15% in patients aged 55–65 years and >65 years.

Conclusions The 2021 ESC guidelines allowed a much better detection of young individuals before their first STEMI than prior ESC guidelines. In secondary prevention, most of young individuals did not reach low-density lipoprotein cholesterol levels recommended, but only one quarter would be eligible for PCSK9i.

  • Atherosclerosis
  • Acute Coronary Syndrome
  • Myocardial Infarction
  • Risk Factors

Data availability statement

Data are available on reasonable request.

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Data availability statement

Data are available on reasonable request.

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  • Twitter @michelzedbay, @DSulman, @docjohanne, @SABOURETCardio, @@ActionCoeur

  • MZ and DS contributed equally.

  • Correction notice This article has been corrected since it was first published online. The proportions in Figure 1 have been corrected for the population of <55 years old with 2021 ESC guidelines, it should be 62.5% of patients eligible for direct intervention.

  • Collaborators Action Study Group.

  • Contributors GM is the author responsible for the overall content as the guarantor. The authors contributed to the manuscript with the following. Substantial contributions to the conception or design: MZ, DS and GM. All the other authors participated in the acquisition, analysis or interpretation of data, in the drafting the work.

  • Funding Action Study Group is funding the register and the statistical analysis.

  • Competing interests GM reports research grants, funding or consulting fees from Abbott, Amgen, AstraZeneca, Axis, Bayer, BMS, Boehringer-Ingelheim, Boston-Scientific, Cell Prothera, CSL Behring, Idorsia, Leo-Pharma, Lilly, Medtronic, Novartis, Pfizer, Quantum Genomics, Sanofi and Terumo; MZ reports research grants, funding or consulting fees from Fédération Française de Cardiologie, Institut Servier, BMS/Pfizer and AstraZeneca; JS reports reports research grants, funding or consulting fees from AstraZeneca, Bayer HealthCare SAS, Abbott Medical France SAS, Biotronik, Boehringer Ingelheim France, CSL Behring SA, Gilead Science, Sanofi-Aventis France, Stockholder of Pharmaseeds, Terumo France SAS and Zoll; MK reports research grants, funding or consulting fees from Fédération Française de Cardiologie, du Programme PHRC N, de l’Institut Servier et des honoraires de Bayer, Sanofi and Servier; PS reports research grants, funding or consulting fees from Amgen, AstraZeneca, Bayer, BMS, Boehringer, Bouchara Recordati, Eli-Lilly, MSD, Novartis, Pfizer, Sanofi, Servier and Vifor; J-PC reports research grants, funding or consulting fees from AstraZeneca, Boston Scientific, Bristol-Myers Squibb, COR2ED, Lead-Up, Medtronic and WebMD; DS, PG, OB, DB and NP report no conflict of interests.

  • Patient and public involvement Patients and/or the public were involved in the design, or conduct, or reporting, or dissemination plans of this research. Refer to the Methods section for further details.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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