Primary percutaneous coronary intervention (pPCI) has been the gold standard treatment for patients with ST-elevation myocardial infarction (STEMI) in Europe for nearly two decades. While short- and medium-term outcomes are well described, data on very long-term mortality, especially in younger patients with longer life expectancy, remain limited.

To analyze very long-term mortality and 20 years relative survival rate compared to the general population in younger patients (≤65 years) with a first STEMI treated by pPCI.

We analyzed a high-volume, single-center registry of unselected STEMI patients treated with pPCI between January 1, 2000, and December 31, 2002. Patients aged ≤65 years with no history of myocardial infarction (MI) were selected. In cooperation with the Institute of Health Information and Statistics of the Czech Republic, we obtained mortality and cause-of-death data (classified by ICD-10) with a censoring date of December 31, 2023. Observed survival was assessed using the Kaplan–Meier method, and relative survival was estimated using the Pohar–Perme method, with expected survival derived from Czech national mortality tables.

A total of 960 patients (71.4 % male, n = 686) with STEMI were treated with pPCI during the three-year study period. Among them, 385 patients (40.1 %) were ≤ 65 years with no previous MI. The mean age at STEMI was 55.03 ± 6.97 years for women (n = 71) and 54.16 ± 6.85 years for men (n = 314; p = 0.168). Over the entire very-long term follow-up period, 211 patients (54.8 %) died; cardiovascular causes were responsible in 111 cases (28.8 %). The 20-year overall survival was 50.6 %, while the 20-year relative survival was 79.5 %.

Despite high overall very-long term mortality in patients treated with primary PCI, the relative 20-year survival compared to the general population remained nearly 80 %. Furthermore, cardiovascular causes accounted for only half of all deaths.