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Celik T, Balta S, Ozturk C, Iyisoy A. Survival of the young patients with acute ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention: Does gender matters? Int J Cardiol 2016; 210:54-5. [PMID: 26925922 DOI: 10.1016/j.ijcard.2016.02.107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2016] [Accepted: 02/14/2016] [Indexed: 12/26/2022]
Affiliation(s)
- Turgay Celik
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik, Ankara, Turkey.
| | - Sevket Balta
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik, Ankara, Turkey
| | - Cengiz Ozturk
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik, Ankara, Turkey
| | - Atila Iyisoy
- Gulhane Military Medical Academy, School of Medicine, Department of Cardiology, Etlik, Ankara, Turkey
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Abstract
Chest pain in young adults presents a unique diagnostic challenge, placing young patients at an increased risk to be misdiagnosed, as this patient population typically does not demonstrate the traditional risk factors associated with cardiovascular disease. This study details the case of a 16-year-old male who presented with new-onset chest pain and ST elevation on electrocardiogram. His history was unremarkable for known cardiac risk factors, but laboratory evaluation demonstrated markedly elevated troponins and electrocardiographic findings confirmed ST-segment elevation myocardial infarction. Coronary angiography demonstrated 100% occlusion of the left anterior descending artery, which was managed with percutaneous transluminal coronary angioplasty, thrombectomy, and bare-metal stenting. The patient had an uneventful recovery. This study examines the major causes of ST elevation myocardial infarction in young adults and reviews the major differences between younger and older myocardial infarction populations with emphasis on risk factor profile, pathophysiological mechanisms, clinical presentation, angiographic findings, and prognosis. This review highlights the need for consideration of a wide differential in younger subsets of the population presenting with chest pain and ST elevation. The implementation of current adult management protocols and guidelines for ST elevation myocardial infarction should not be overlooked due to age. Given the potential for premature death and long-term disability with resulting individual and societal consequences, it is crucial to understand the importance of correct diagnostic evaluation in this clinical scenario.
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Haseeb A, Bilal M, Dar MI, Arshad MH, Amir RB, Hussain SMH, Mian SK, Javed M, Sultan A, Arfeen AA. Predictors of Knowledge of Coronary Intervention in a Group of PCI Patients. Glob J Health Sci 2015; 8:187-95. [PMID: 26755481 PMCID: PMC4954896 DOI: 10.5539/gjhs.v8n6p187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 10/09/2015] [Accepted: 09/28/2015] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVE This study was performed to assess the knowledge of CAD risk factors and post management of coronary intervention among sample of population who were hospitalized for PCI. METHODOLOGY A cross-sectional, descriptive survey was conducted in Cardiology ward of a tertiary care hospital from July 2013 to May 2015 on 600 patients. A structured questionnaire was used to interview the patients. In univariate analysis, t-tests were employed to assess association of knowledge of CAD risk factors with gender, education level and monthly household income. RESULTS The mean score of participants with no education was 4.42 and patients with education of bachelors or higher was 8.59 (p-value: 0.01). Similarly, the mean score for participants with monthly household income less than 5000 was 3.32 and participants with income higher than 50,000 had a score of 8.31 (p-value: 0.01). Furthermore, only 28% (N=168) claimed aerobic exercise as a key part of angioplasty recovery. CONCLUSIONS Our results indicate the lack of good level of knowledge of risk factors for CAD and post management of coronary intervention among PCI patients of Pakistan. There is urgent need for targeted educational programs on national basis to reduce mortality associated with CAD in Pakistani population.
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Affiliation(s)
- Abdul Haseeb
- Dow University Of Health Sciences, Karachi, Pakistan.
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Karim MA, Majumder AAS, Islam KQ, Alam MB, Paul ML, Islam MS, Chowdhury KN, Islam SMS. Risk factors and in-hospital outcome of acute ST segment elevation myocardial infarction in young Bangladeshi adults. BMC Cardiovasc Disord 2015. [PMID: 26197888 PMCID: PMC4509563 DOI: 10.1186/s12872-015-0069-2] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Background South Asians have a higher overall incidence rate and younger age of onset for acute myocardial infarction (AMI) compared to Western populations. However, limited information is available on the association of preventable risk factors and outcomes of AMI among young individuals in Bangladesh. The aim of this study was to determine the risk factors and in-hospital outcome of AMI among young (age ≤40 years) adults in Bangladesh. Methods We conducted a prospective observational study among consecutive 50 patients aged ≤40 years and 50 patients aged >40 years with acute ST Segment Elevation Myocardial Infarction (STEMI) and followed-up in-hospital at the National Institute of Cardiovascular Diseases (NICVD). Clinical characteristics, biochemical findings, diet, echocardiography and in-hospital outcomes were compared between the two groups. Multivariate logistic regression was performed to assess the association between risk factors and in-hospital outcome in young patients adjusting for other confounding variables. Results The mean age of the young and older patient groups was 36.5 ± 4.6 years and 57.0 ± 9.1 years respectively. Male sex (OR 3.4, 95 % CI 1.2 − 9.75), smoking (OR 2.4, 95 % CI 1.04 − 5,62), family history of MI (OR 2.4, 95 % CI 1.11 − 5,54), homocysteine (OR 1.2, 95 % CI 1.08 − 1.36), eating rice ≥2 times daily (OR 3.5, 95 % CI 1.15 − 10.6) and eating beef (OR 4.5, 95 % CI 1.83 − 11.3) were significantly associated with the risk of AMI in the young group compared to older group. In multivariate analysis, older patients had significantly greater chance of developing heart failure (OR 7.5, 95 % CI 1.51 to 37.31), re-infarction (OR 7.0, 95 % CI 1.08 − 45.72), arrhythmia (OR 15.3, 95 % CI 2.69 − 87.77) and cardiogenic shock (OR 69.0, 95 % CI 5.81 − 85.52) than the younger group. Conclusion Younger AMI patients have a different risk profile and better in-hospital outcomes compared to the older patients. Control of preventable risk factors such as smoking, unhealthy diet, obesity and dyslipidemia should be reinforced at an early age in Bangladesh.
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Affiliation(s)
| | | | | | | | | | | | - Kamrun N Chowdhury
- Department of Epidemiology, National Centre for Control of Rheumatic Fever and Heart Disease, Dhaka, Bangladesh.
| | - Sheikh Mohammed Shariful Islam
- International Center for Diarrhoeal Disease Research, Bangladesh, Center for Control of Chronic Diseases, Dhaka, Bangladesh. .,Center for International Health, University of Munich, Munich, Germany. .,Cardiovascular Division, The George Institute for Global Health, Sydney, Australia.
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Khan RJ, Stewart CP, Davis SK, Harvey DJ, Leistikow BN. The risk and burden of smoking related heart disease mortality among young people in the United States. Tob Induc Dis 2015; 13:16. [PMID: 26146496 PMCID: PMC4490760 DOI: 10.1186/s12971-015-0041-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 06/12/2015] [Indexed: 11/17/2022] Open
Abstract
PURPOSE Although cigarette smoking remains the most common risk factor for heart disease among the young, few studies have explored the relationship of smoking with heart disease mortality risk among young people. This prospective study assesses the risk and burden of all heart disease (HD) and coronary heart disease (CHD) mortality associated with smoking among younger adults from a nationally representative sample of the United States. METHOD National Health Interview Survey respondents' data from 1997-2004 were linked to their death records through 2006. The analyses were restricted to individuals 18 to 44 years of age during follow up (n = 121,284). Cox proportional hazard ratios (HR) were estimated with adjustment for sample weights and design effects. Attributable fractions (AF) of smoking were calculated. RESULTS After controlling for age, race, body mass index, history of hypertension and diabetes, and leisure time physical activity, current smoking related CHD mortality HR was 14.6 [95 % confidence interval or CI, 3.3-64.9] for females and 3.6 [95 % CI, 1.2-10.4] for males. The HR for all HD mortality was 3.1 [95 % CI, 1.3-7.6] for females and 2.4 [95 % CI, 1.2-4.7] for males. The AF of smoking for CHD deaths for female and male were 0.58 and 0.54 respectively. The AF of all HD mortality was 0.31 for male and 0.32 for female. The mean estimates of all HD deaths attributable to smoking during 1997-2006 among this age group were 52,214, of which 45,147 were CHD deaths. CONCLUSION Even after adjustment for multiple risk factors and without addressing passive smoking, our result showed a strong relationship between smoking and HD and CHD mortality among young adults that is likely causal.
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Affiliation(s)
- Rumana J. Khan
- />Graduate group in Epidemiology, University of California, 5215 VM3A, One Shields Avenue, Davis, CA 95616 USA
- />National Human Genome Research Institute, Genomics of Metabolic, Cardiovascular and Inflammatory Disease Branch, Social Epidemiology Research Unit, 10 Center Drive, Bethesda, MD USA
| | - Christine P. Stewart
- />Program in International and Community Nutrition, University of California, 3253B Meyer, One Shields Avenue, Davis, CA 95616 USA
| | - Sharon K. Davis
- />National Human Genome Research Institute, Genomics of Metabolic, Cardiovascular and Inflammatory Disease Branch, Social Epidemiology Research Unit, 10 Center Drive, Bethesda, MD USA
| | - Danielle J. Harvey
- />Department of Public Health Sciences, University of California, One Shields Avenue, Med Sci 1-C, Davis, CA 95616-8638 USA
| | - Bruce N. Leistikow
- />Department of Public Health Sciences, University of California, One Shields Avenue, Med Sci 1-C, Davis, CA 95616-8638 USA
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Distelmaier K, Wiesbauer F, Blessberger H, Oravec S, Schrutka L, Binder C, Dostal E, Schillinger M, Wojta J, Lang IM, Maurer G, Huber K, Goliasch G. Impaired antioxidant HDL function is associated with premature myocardial infarction. Eur J Clin Invest 2015; 45:731-8. [PMID: 25989880 DOI: 10.1111/eci.12466] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2015] [Accepted: 05/16/2015] [Indexed: 01/03/2023]
Abstract
BACKGROUND There is growing evidence that the predictive value of HDL cholesterol levels for cardiovascular risk stratification is limited in patients with coronary artery disease (CAD). HDL function seems to be a more sensitive surrogate of cardiovascular risk estimation than simple serum levels. Therefore, we aimed to assess whether impaired antioxidant HDL function is involved in the development of premature acute myocardial infarction (AMI). METHODS In this multicentre case-control study, we compared the antioxidant function of HDL, measured by the HDL inflammatory index (HII), and HDL particle size in 184 patients comprising 92 patients with AMI at a very young age (≤40 years of age) and 92 age- and gender-matched controls. RESULTS Antioxidant capacities of HDL were significantly impaired in the acute phase of AMI (HII of 1·50 [IQR 1·10-1·74] vs. 0·56 [IQR 0·41-0·86] in controls, P < 0·001 as well as in the chronic stable phase 1 year after the event (HII of 0·85 [IQR 0·72-1·03] vs. 0·56 [IQR 0·41-0·86], P < 0·001) compared to controls. Moreover, HDL function in the stable phase remained significantly associated with premature MI in adjusted logistic regression analysis with an OR of 2·24 per SD increase of HII (95% CI 1·28-3·91; P = 0·005). Analyses of HDL size revealed a significant correlation between all HDL subfractions and HDL function in controls, whereas this correlation was lost for large and intermediate HDL in AMI patients. CONCLUSION Impaired antioxidant function of HDL is independently associated with the development of premature AMI. The maintenance of HDL function might evolve into a significant therapeutic target, especially in patients with premature CAD.
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Affiliation(s)
- Klaus Distelmaier
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Franz Wiesbauer
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Hermann Blessberger
- Department of Internal Medicine I - Cardiology, Linz General Hospital, Johannes Kepler University School of Medicine, Linz, Austria
| | - Stanislav Oravec
- Department of Internal Medicine II, University of Bratislava, Bratislava, Slovakia
| | - Lore Schrutka
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Christina Binder
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | | | - Martin Schillinger
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Johann Wojta
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria.,Ludwig Boltzmann Cluster for Cardiovascular Research, Vienna, Austria.,Core Facilities, Medical University of Vienna, Vienna, Austria
| | - Irene M Lang
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Gerald Maurer
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
| | - Kurt Huber
- Third Medical Department, Cardiology and Intensive Care Medicine, Wilhelminenhospital, Vienna, Austria
| | - Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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Lee SH, Kim JH, Jeong MH, Park H, Jeong YA, Ahn Y, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi D, Cho MC, Kim CJ, Seung KB, Chung WS, Jang YS, Cho JG, Park JC, Park SJ. Clinical Characteristics and Outcomes of Acute ST-Segment Elevation Myocardial Infarction in Younger Korean Adults. Korean Circ J 2015; 45:275-84. [PMID: 26240581 PMCID: PMC4521105 DOI: 10.4070/kcj.2015.45.4.275] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2015] [Revised: 04/08/2015] [Accepted: 04/09/2015] [Indexed: 11/16/2022] Open
Abstract
Background and Objectives This study aims to investigate the clinical features, angiographic findings, and outcomes of younger Korean ST-segment elevation myocardial infarction (STEMI) patients. Subjects and Methods We analyzed major adverse cardiac events (MACE) in the Korea Acute Myocardial Infarction Registry from November 2005 to October 2010. The registered patients were divided into two groups; young age group (<65 years) and old age group (≥65 years). Results The young age group included 5281 patients (age, 53±7.8 years), and the old age group included 4896 patients (age, 74.3±6.5 years). Male gender, smoking, family history, dyslipidemia, and metabolic syndrome were more frequently observed in the young age group than in the old age group (89.5% vs. 59.3%, p<0.001; 77.3% vs. 47.2%, p<0.001; 11% vs. 4.6%, p<0.001; 11.2% vs. 7.7%, p<0.001; 67.6% vs. 62.9%, p<0.001). Most of the young Korean adults with STEMI complained of typical chest pain (89.8%), and they had a shorter symptom-to-door time (12±53.2 hours vs. 17.3±132 hours, p=0.010). The young age group showed a favorable prognosis, which was represented by the MACE, compared with the old age group at one month (1.8% vs. 2.8%, p=0.028), six months (6.8% vs. 8.2%, p<0.001), and twelve months (10.1% vs. 11.9%, p=0.025). However, there was no significant difference in the adjusted MACE rate at one month {hazard ratio (HR) 0.95, 95% confidence interval (CI) 0.60-1.51, p=0.828} and twelve months (HR 0.86, 95% CI 0.68-1.10, p=0.233). Conclusion Younger Korean adults with STEMI have clinical outcomes similar to old aged patients, and therefore, they should be treated intensively like the elderly patients.
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Affiliation(s)
- Seung Hun Lee
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Ju Han Kim
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Myung Ho Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Hyukjin Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Yun Ah Jeong
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Youngkeun Ahn
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jong Hyun Kim
- The Cardiovascular Center, Hanseo Hospital, Busan, Korea
| | - Shung Chull Chae
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Korea
| | - Young Jo Kim
- Department of Internal Medicine, Yeungnam University Hospital, Daegu, Korea
| | - Seung Ho Hur
- Department of Internal Medicine, Keimyung University Dongsan Medical Center, Daegu, Korea
| | - In Whan Seong
- Department of Internal Medicine, Chungnam National University Hospital, Daejeon, Korea
| | - Taek Jong Hong
- Department of Internal Medicine, Pusan National University Hospital, Busan, Korea
| | - Donghoon Choi
- Department of Internal Medicine, Yonsei University Severans Hospital, Seoul, Korea
| | - Myeong Chan Cho
- Department of Internal Medicine, Chungbuk National University Hospital, Cheongju, Korea
| | - Chong Jin Kim
- Department of Internal Medicine, Kyunghee University College of Medicine, Seoul, Korea
| | - Ki Bae Seung
- Department of Internal Medicine, The Catholic University of Korea Hospital, Seoul, Korea
| | - Wook Sung Chung
- Department of Internal Medicine, The Catholic University of Korea Hospital, Seoul, Korea
| | - Yang Soo Jang
- Department of Internal Medicine, Yonsei University Severans Hospital, Seoul, Korea
| | - Jeong Gwan Cho
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Jong Chun Park
- The Heart Center of Chonnam National University Hospital, Gwangju, Korea
| | - Seung Jung Park
- Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Rathod KS, Jones DA, Gallagher S, Rathod VS, Weerackody R, Jain AK, Mathur A, Mohiddin SA, Archbold RA, Wragg A, Knight CJ. Atypical risk factor profile and excellent long-term outcomes of young patients treated with primary percutaneous coronary intervention for ST-elevation myocardial infarction. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2015; 5:23-32. [PMID: 25589633 DOI: 10.1177/2048872614567453] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2014] [Accepted: 12/17/2014] [Indexed: 01/29/2023]
Abstract
INTRODUCTION Several studies have examined the relationship between age and clinical outcomes in patients with ST-elevation myocardial infarction (STEMI) treated by primary percutaneous coronary intervention (PPCI). The majority of studies have concentrated on describing elderly patients and there has been less focus on the profile and outcome of young patients suffering from STEMI. The aim of this study was to describe the clinical profile and outcomes of young patients compared with an older cohort and to establish what risk factors were associated with young patients having PPCI for STEMI. METHODS This was an observational cohort study of 3618 patients with STEMI treated by PPCI at a regional heart attack centre in London between January 2004 and September 2012. Clinical characteristics and outcomes in (young) patients aged ≤ 45 years were compared with those in (older) patients aged >45 years. The primary and main secondary outcomes were all-cause mortality and major adverse cardiovascular event rates, respectively, at a median follow-up of 3.0 (interquartile range 1.2-4.6) years. RESULTS Of the 3618 patients, 367 (10.1%) were aged ≤ 45 years and 3251 (89.9%) were aged >45 years. The proportion of patients aged ≤ 45 years increased from 8.5% to 11.5% (p=0.04) during the study period. Compared with older patients, those aged ≤ 45 years were more likely to be male, smokers, of South Asian ethnicity and to have a family history of premature coronary artery disease. Young patients were less likely to have a history of hypertension, hypercholesterolaemia, diabetes mellitus, previous myocardial infarction, myocardial revascularisation, or to have left ventricular systolic impairment or renal impairment. Over the follow-up period, mortality (2.7% vs. 7.6%; p<0.0001) and major adverse cardiovascular event rates (7.0% vs. 13.5%; p<0.0001) were significantly lower in patients aged ≤ 45 years compared with older patients. After adjustment for potential confounding factors, young age remained a predictor of reduced all cause mortality when compared with older patients (hazard ratio 0.12 (95% confidence interval 0.04-0.38)), including after incorporation of a propensity score (hazard ratio: 0.14 (95% confidence interval 0.04-0.36)). CONCLUSIONS In this cohort of patients with STEMI treated by PPCI there was an increasing incidence of young patients aged ≤ 45 years throughout the study period. These patients were more often male, smokers and of South Asian ethnicity. Outcomes in younger patients was good. Focusing preventative strategies on smokers and high risk ethnic groups may help reduce the incidence of premature coronary artery disease.
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Affiliation(s)
- Krishnaraj S Rathod
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Daniel A Jones
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Sean Gallagher
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Vrijraj S Rathod
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK
| | - Roshan Weerackody
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Ajay K Jain
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Anthony Mathur
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Saidi A Mohiddin
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - R Andrew Archbold
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Andrew Wragg
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK Department of Clinical Pharmacology, William Harvey Research Institute, Queen Mary University, London, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
| | - Charles J Knight
- Department of Cardiology, Barts Health NHS Trust, London Chest Hospital, UK NIHR Cardiovascular Biomedical Research Unit, London Chest Hospital, UK
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Colombo F, Zuffi A, Lupi A. Left main dissection complicating blunt chest trauma: Case report and review of literature. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2014; 15:354-6. [DOI: 10.1016/j.carrev.2014.04.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2014] [Revised: 04/02/2014] [Accepted: 04/09/2014] [Indexed: 01/24/2023]
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Esteban MR, Montero SM, Sánchez JJA, Hernández HP, Pérez JJG, Afonso JH, Pérez DCR, Díaz BB, de León AC. Acute coronary syndrome in the young: clinical characteristics, risk factors and prognosis. Open Cardiovasc Med J 2014; 8:61-7. [PMID: 25152777 PMCID: PMC4141177 DOI: 10.2174/1874192401408010061] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Revised: 05/20/2014] [Accepted: 06/06/2014] [Indexed: 12/18/2022] Open
Abstract
Background: To describe the characteristics of patients ≤40 years of age hospitalized for acute coronary syndrome, analyze the risk factors and identify the variables associated with prognosis. Methods: Case series of patients admitted between 2003 and 2012 inclusive in a tertiary hospital (123 consecutive cases admitted between 2003 and 2012), and case-control study (369 controls selected from the general population matched for sex and age with cases, at a ratio of 3:1). Outcome variables: Mortality, likelihood of survival without readmission for heart-related problems, extent of coronary disease as determined by coronary angiography and cardiovascular risk factors. Results: Mean age was 35.4±4.8 years and 83.7% of the participants were men. Myocardial infarction with abnormal Q wave (48%) and single-vessel involvement (44.7%) predominated. Intrahospital mortality was 1.6%. For the 108 patients eventually included in the follow-up, likelihood of readmission-free survival after 60 months was 69.3±4.8%. In the case group 36% of the patients admitted to using cocaine. Compared to controls, the prevalence in patients was higher for smoking (74.8 vs 33.1%, p<0001), diabetes (14.6% vs 5.1%, p=0.001), low HDL-cholesterol (82.9 vs 34.1%, p<0.001) and obesity (30.0 vs 20.3%, p=0.029). Decreased left ventricular ejection fraction (odds ratio=2.2, p=0.033) and smoking (odds ratio=7.8, p=0.045) were associated with readmission for coronary syndrome. Conclusion: Acute coronary syndrome in people younger than 40 years is associated with diabetes and unhealthy lifestyle: smoking, sedentary behavior (low HDL-cholesterol), cocaine use and obesity. The readmission rate is high, and readmission is associated with smoking and decreased ejection fraction.
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Affiliation(s)
| | - Sara M Montero
- Unidad de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
| | - José J A Sánchez
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | | | | | | | - Del C R Pérez
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Buenaventura B Díaz
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
| | - Antonio C de León
- Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain ; Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain ; Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
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In-hospital and 12-month outcomes after acute coronary syndrome treatment in patients aged<40 years of age (from the Polish Registry of Acute Coronary Syndromes). Am J Cardiol 2014; 114:175-80. [PMID: 24878122 DOI: 10.1016/j.amjcard.2014.04.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 12/12/2022]
Abstract
We aimed to compare the characteristics and in-hospital and 12-month outcomes in patients aged>40 and <40 years with acute coronary syndrome. The analysis involved 789 patients aged<40 years and 63,057 patients aged≥40 years enrolled in the ongoing Polish Registry of Acute Coronary Syndromes from October 2003 to December 2009. Patients aged<40 years with acute coronary syndrome differed from older patients in their clinical characteristics, treatment, and clinical outcome. The older patients more frequently had pulmonary edema (2.9% vs 0.4%, p<0.0001) and cardiogenic shock (4.7% vs 2.8%, p=0.011) on admission. For the younger patients, coronary angiography and percutaneous coronary intervention were performed more often (71.5% vs 60.5%, p<0.0001 and 51.5% vs 47.7%, p=0.04, respectively). The younger patients had a lower mortality rate than the older patients during hospitalization (1.5% vs 5.2%, p<0.0001) and during 12-month follow-up period (4.1% vs 13.4%, p<0.0001). Multivariate analysis revealed that age<40 years was one of the strongest factors associated with lower mortality during the 12 months after discharge (hazard ratio 0.42, 95% confidence interval 0.29 to 0.62, p<0.0001). In conclusion, younger patients had more favorable in-hospital and 1-year outcomes than older patients, and the age<40 years was revealed to be one of the strongest factors associated with lower mortality during the 1-year follow-up.
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Abstract
Background—
Growing evidence supports an association between venous thromboembolism (VTE) and arterial thrombotic diseases (ie, myocardial infarction and ischemic stroke). We aimed to study the association between VTE and future arterial events and to determine the population attributable risk of arterial events by VTE in a large prospective cohort recruited from the general population.
Methods and Results—
In 1994 to 1995 and 1993 to 1997, 81 687 subjects were included in the Tromsø Study and in the Diet, Cancer and Health Study and followed up to the date of incident venous and arterial events (myocardial infarction or ischemic stroke), death or migration, or to the end of the study period (2010 and 2008, respectively). There were 1208 cases of VTE and 90 subsequent arterial events during a median follow-up of 12.2 years. An association between VTE and future arterial events was found in all women and men aged <65 years but not in men aged >65 years. Women <65 years old with VTE had 3.3-fold higher risk of arterial disease (adjusted hazard ratio, 3.28; 95% confidence interval, 1.69–6.35) compared with women of the same age without VTE. The corresponding hazard ratio in men aged <65 years was 2.06 (95% confidence interval, 1.32–3.20). Only 0.9% of the arterial events were attributed to VTE, and the VTE explained 63.8% of the risk of arterial events among VTE patients.
Conclusions—
Our findings imply that women and young men with VTE have higher risk of arterial thrombotic disease than those without VTE. However, only 1% of the arterial thrombotic events in the population are attributed to VTE.
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Kivrak T, Sunbul M, Durmus E, Dervisova R, Sari I, Yesildag O. Acute myocardial infarction due to liquid nicotine in a young man. Ther Adv Cardiovasc Dis 2014; 8:32-4. [DOI: 10.1177/1753944713515765] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tarik Kivrak
- Marmara University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Murat Sunbul
- Marmara University Faculty of Medicine, Department of Cardiology, Fevzi Cakmak Mahallesi, Mimar Sinan Caddesi, No. 41, Ustkaynarca, Pendik, Istanbul, Turkey
| | - Erdal Durmus
- Marmara University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Ramile Dervisova
- Marmara University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Ibrahim Sari
- Marmara University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
| | - Osman Yesildag
- Marmara University Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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64
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The Demographic Profile of Young Patients (<45 years-old) with Acute Coronary Syndromes in Queensland. Heart Lung Circ 2014; 23:49-55. [DOI: 10.1016/j.hlc.2013.05.648] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Revised: 04/09/2013] [Accepted: 05/25/2013] [Indexed: 11/20/2022]
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Sulo G, Igland J, Nygård O, Vollset SE, Ebbing M, Tell GS. Favourable trends in incidence of AMI in Norway during 2001–2009 do not include younger adults: a CVDNOR project. Eur J Prev Cardiol 2013; 21:1358-64. [DOI: 10.1177/2047487313495993] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
| | | | - Ottar Nygård
- University of Bergen, Bergen, Norway
- Haukeland University Hospital, Bergen, Norway
| | - Stein Emil Vollset
- University of Bergen, Bergen, Norway
- Norwegian Institute of Public Health, Bergen, Norway
| | - Marta Ebbing
- Norwegian Institute of Public Health, Bergen, Norway
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66
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Cutting-edge issues in coronary disease and the primary antiphospholipid syndrome. Clin Rev Allergy Immunol 2013; 44:51-6. [PMID: 21403998 DOI: 10.1007/s12016-011-8268-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Antiphospholipid syndrome (APS) is the most frequent cause of venous and arterial thrombotic events in young patients. The brain arterial tree is primarily affected, but coronary ischemic manifestations are also relatively frequent. Coronary involvement was suggested to be closely related to the accelerated atherosclerosis linked to the underlying disease in APS associated to systemic autoimmune diseases, in particular, systemic lupus erythematosus. However, arterial ischemic events can occur in primary APS--with no other systemic disorders--even in the absence of traditional cardiovascular risk factors and overt atherosclerosis. From a biological point of view, this finding speaks in favor for a pro-coagulant activity of anti-phospholipid antibodies rather than for their role in atherosclerotic plaque formation. On the other hand, the clinical challenge is to avoid the risk to misdiagnose young patients with potentially life-threatening symptoms, such as myocardial infarction (MI). In fact, the occurrence of nonspecific symptoms related to coronary ischemic events is frequently misdiagnosed because of its rarity in young patients. This issue is well illuminated by two cases of MI in young patients reported in the manuscript together with a systematic review of the associations and implications of coronary ischemic events in APS.
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67
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Egiziano G, Akhtari S, Pilote L, Daskalopoulou SS. Sex differences in young patients with acute myocardial infarction. Diabet Med 2013. [PMID: 23190156 DOI: 10.1111/dme.12084] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIMS To identify sex differences in risk factors, presenting symptoms and outcomes of young patients with acute myocardial infarction. METHODS We adopted a comprehensive approach and performed two parallel studies: (1) using provincial administrative databases from Quebec, Canada from 2000 to 2007, we identified baseline characteristics and post-acute myocardial infarction survival of patients aged < 50 years (n = 10,619); (2) to overcome the lack of clinical data in the administrative databases, a medical chart review was performed on 215 patients < 50 years of age with an acute myocardial infarction between April 2000 and August 2006 from our institution. RESULTS Administrative cohort: fewer women than men sought medical attention for retrosternal chest pain 1-month pre-acute myocardial infarction (P = 0.035). Diabetes and hypertension were more prevalent in women, and patients equally received interventional procedures post-infarction. Diabetes significantly reduced post-infarction survival in men and women [HR = 2.02 (95% CI 1.21-3.36) and HR = 2.25 (95% CI 1.06-4.80), respectively]. However, young women had greater post-infarction mortality in-hospital and up to 1 year after discharge (4.23% vs. 2.21%, respectively; P = 0.005). Medical chart review: diabetes and hypertension were more prevalent in women, while men were more obese. There were no significant sex differences in typical presenting symptoms, or in interventional procedures post-infarction. CONCLUSIONS Young men and women with acute myocardial infarctions equally presented with retrosternal chest pain, although fewer women sought medical attention for retrosternal chest pain before admission. Diabetes and hypertension were more prevalent in young women, and mortality was higher in young female patients. Our results highlight the continued need for diabetes prevention and control in young patients, especially women.
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Affiliation(s)
- G Egiziano
- Department of Medicine, McGill University Health Centre Research Institute, McGill University, Montreal, QC, Canada
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68
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Tomaiuolo R, Bellia C, Caruso A, Di Fiore R, Quaranta S, Noto D, Cefalù AB, Di Micco P, Zarrilli F, Castaldo G, Averna MR, Ciaccio M. Prothrombotic gene variants as risk factors of acute myocardial infarction in young women. J Transl Med 2012; 10:235. [PMID: 23171482 PMCID: PMC3543285 DOI: 10.1186/1479-5876-10-235] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 10/02/2012] [Indexed: 01/04/2023] Open
Abstract
Background Acute myocardial infarction (AMI) in young women represent an extreme phenotype associated with a higher mortality compared with similarly aged men. Prothrombotic gene variants could play a role as risk factors for AMI at young age. Methods We studied Factor V Leiden, FII G20210A, MTHFR C677T and beta-fibrinogen -455G>A variants by real-time PCR in 955 young AMI (362 females) and in 698 AMI (245 females) patients. The data were compared to those obtained in 909 unrelated subjects (458 females) from the general population of the same geographical area (southern Italy). Results In young AMI females, the allelic frequency of either FV Leiden and of FII G20210A was significantly higher versus the general population (O.R.: 3.67 for FV Leiden and O.R.: 3.84 for FII G20210A; p<0.001). Among AMI patients we showed only in males that the allelic frequency of the MTHFR C677T variant was significantly higher as compared to the general population. Such difference was due to a significantly higher frequency in AMI males of the MTHFR C677T variant homozygous genotype (O.R. 3.05). Discussion and conclusion Our data confirm that young AMI in females is a peculiar phenotype with specific risk factors as the increased plasma procoagulant activity of FV and FII. On the contrary, the homozygous state for the 677T MTHFR variant may cause increased levels of homocysteine and/or an altered folate status and thus an increased risk for AMI, particularly in males. The knowledge of such risk factors (that may be easily identified by molecular analysis) may help to improve prevention strategies for acute coronary diseases in specific risk-group subjects.
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Affiliation(s)
- Rossella Tomaiuolo
- CEINGE-Biotecnologie Avanzate, Via Gaetano Salvatore 486, Naples, 80145, Italy
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Russo A, Palumbo L, Fornengo C, Di Gaetano C, Ricceri F, Guarrera S, Critelli R, Anselmino M, Piazza A, Gaita F, Bergerone S, Matullo G. Telomere length variation in juvenile acute myocardial infarction. PLoS One 2012; 7:e49206. [PMID: 23145125 PMCID: PMC3492293 DOI: 10.1371/journal.pone.0049206] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2012] [Accepted: 10/07/2012] [Indexed: 11/19/2022] Open
Abstract
Leukocyte telomere length (LTL) provides a potential marker of biological age, closely related to the endothelial dysfunction and consequently to the atherosclerotic process. To investigate the relationship between the LTL and the risk of premature acute myocardial infarction and to evaluate the predictive value of LTL on the onset of major cardiovascular events, 199 patients from 18 to 48 years old with first diagnosis of acute myocardial infarction were enrolled and were matched with 190 controls for sex and age (± 1 year). Clinical data and coronary artery disease were evaluated at enrollment and at follow up. LTL was measured at enrollment using a quantitative PCR-based method. No significant differences were observed in LTL between cases and controls (p = 0.20) and with the presence of coronary artery disease in patients (p = 0.47). Hypercholesterolemic cases presented LTL significantly longer than cases without hypercholesterolemia (t/s: 0.82 ± 0.16 p = 0.79 and t/s norm: 0.79 ± 0.19 p = 0.01), as confirmed in multivariate regression analysis (p = 0.005, β = 0.09). Furthermore, multivariate regression analysis showed LTL significantly shorter in hypertensive cases than in normotensive cases (p = 0.04, β = -0.07). One hundred seventy-one cases (86%) ended the average follow up of 9 ± 5 years, 92 (54%) presented a major cardiovascular event. At multivariate regression analysis the LTL detected at enrollment did not represent a predictive factor of major cardiovascular events nor it significantly impacted with cumulative events. Based on present cohort of young Italian patients, the LTL did not represent a marker of acute myocardial infarction nor had a predictive role at medium term follow up.
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Affiliation(s)
- Alessia Russo
- Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy
- HuGeF, Human Genetics Foundation, Turin, Italy
| | - Luigi Palumbo
- Department of Internal Medicine, University of Turin, Cardiology Division, San Giovanni Battista Hospital, Turin, Italy
| | - Cristina Fornengo
- Department of Internal Medicine, University of Turin, Cardiology Division, San Giovanni Battista Hospital, Turin, Italy
| | - Cornelia Di Gaetano
- Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy
- HuGeF, Human Genetics Foundation, Turin, Italy
| | - Fulvio Ricceri
- Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy
- HuGeF, Human Genetics Foundation, Turin, Italy
| | | | - Rossana Critelli
- Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy
- HuGeF, Human Genetics Foundation, Turin, Italy
| | - Matteo Anselmino
- Department of Internal Medicine, University of Turin, Cardiology Division, San Giovanni Battista Hospital, Turin, Italy
| | - Alberto Piazza
- Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy
- HuGeF, Human Genetics Foundation, Turin, Italy
| | - Fiorenzo Gaita
- Department of Internal Medicine, University of Turin, Cardiology Division, San Giovanni Battista Hospital, Turin, Italy
| | - Serena Bergerone
- Department of Internal Medicine, University of Turin, Cardiology Division, San Giovanni Battista Hospital, Turin, Italy
| | - Giuseppe Matullo
- Department of Genetics, Biology and Biochemistry, University of Turin, Turin, Italy
- HuGeF, Human Genetics Foundation, Turin, Italy
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70
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Circadian variation of acute myocardial infarction in young people. Am J Emerg Med 2012; 30:1461-5. [DOI: 10.1016/j.ajem.2011.11.019] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Revised: 11/02/2011] [Accepted: 11/24/2011] [Indexed: 11/19/2022] Open
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Ely S, Chandra A, Mani G, Drake W, Freeman D, Limkakeng AT. Utility of observation units for young emergency department chest pain patients. J Emerg Med 2012; 44:306-12. [PMID: 22975283 DOI: 10.1016/j.jemermed.2012.07.048] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 03/14/2012] [Accepted: 07/01/2012] [Indexed: 01/23/2023]
Abstract
BACKGROUND Determining which patients presenting to the Emergency Department (ED) require further work-up for acute coronary syndrome (ACS) can be difficult. The utility of routine observation for cardiac testing in low-risk young adult patients has been questioned. STUDY OBJECTIVES We investigated the rate of positive findings yielded by routine cardiac observation unit work-up in patients aged 40 years or younger. METHODS This was a retrospective observational cohort study of patients aged 18-40 years who were evaluated for ACS in an ED-based observation unit. Data were collected by trained abstractors from electronic medical records. RESULTS A total of 362 patients met inclusion criteria. Of those, 239 received stress testing, yielding five positive and nine indeterminate results. One other patient had acute troponin elevation while under observation. The positive stress test patients and troponin-elevated patient underwent cardiac angiography. Only one positive stress test patient showed significant coronary stenosis and received coronary interventions. In follow-up data, one patient had an adverse cardiac outcome within 1 year of index visit, but no coronary interventions. Thus, only 3 patients had adverse cardiac events, with only one patient warranting intervention discovered by observation unit stress testing and a second via serial cardiac markers. CONCLUSION Routine observation of symptomatic young adults for ACS had low yield. Observation identified one patient with acute cardiac marker elevation and further stress testing identified only one patient with intervenable ACS, despite a high false-positive rate. This suggests that observation and stress testing should not be routinely performed in this demographic absent other high-risk features.
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Affiliation(s)
- Sora Ely
- Division of Emergency Medicine, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
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72
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van Loon JE, de Maat MPM, Deckers JW, van Domburg RT, Leebeek FWG. Prognostic markers in young patients with premature coronary heart disease. Atherosclerosis 2012; 224:213-7. [PMID: 22818563 DOI: 10.1016/j.atherosclerosis.2012.06.067] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Revised: 06/27/2012] [Accepted: 06/28/2012] [Indexed: 12/26/2022]
Abstract
OBJECTIVES To evaluate the survival and prognostic implications of cardiovascular, inflammatory and prothrombotic risk factors in young patients with premature coronary heart disease (CHD). METHODS Follow-up data were obtained from 353 young patients with a first cardiac event (men ≤45 years and women ≤55 years). Baseline characteristics on traditional risk factors were collected at the time of the first event, and plasma levels of C-reactive protein (CRP), von Willebrand Factor (VWF), and fibrinogen were measured one to three months after the first event to exclude an acute phase response. We performed age and sex adjusted Cox regression analyses to assess the relationship between these factors and recurrent events with three different endpoints: all cause mortality, recurrent cardiac event (myocardial infarction or revascularisation procedure), and any recurrent event (cardiac event, cerebrovascular event or all cause mortality). RESULTS During a total follow-up time of 1483 person years (mean 4.2 years), 11 patients died (3%), 42 patients had a recurrent cardiac event (12%), and 53 patients had any recurrent event (15%). CRP was associated with an increased risk of any recurrent event (HR 1.28[95% CI = 1.02-1.59] per unit increase in lnCRP). Also, both CRP (5.00[1.04-24.04]) and fibrinogen (5.04[1.05-24.23]) were associated with all cause mortality when levels were above the 50th percentile. CONCLUSIONS Fifteen percent of young patients with a first cardiac event have a recurrent event or die within a median follow-up of 4.2 years. In these young patients we have shown that, independently of cardiovascular risk factors, high CRP levels contribute to the risk of recurrent events, including all cause mortality, and high fibrinogen levels are associated with all cause mortality.
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Affiliation(s)
- Janine E van Loon
- Department of Haematology, Erasmus University Medical Center, Rotterdam, the Netherlands
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73
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Wong CP, Loh SY, Loh KK, Ong PJL, Foo D, Ho HH. Acute myocardial infarction: Clinical features and outcomes in young adults in Singapore. World J Cardiol 2012; 4:206-10. [PMID: 22761974 PMCID: PMC3386311 DOI: 10.4330/wjc.v4.i6.206] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2012] [Revised: 06/19/2012] [Accepted: 06/23/2012] [Indexed: 02/06/2023] Open
Abstract
AIM To investigate the clinical features and in-hospital outcomes of young adults with acute myocardial infarction (AMI) in Singapore. METHODS Between January 2005 to September 2010, 333 consecutive patients aged ≤ 45 years old were diagnosed to have AMI at our institution. As Singapore is a multi-ethnic society, we also analysed whether ethnic differences exist between the three dominant ethnic groups, Malay, Chinese and Indian with regards to the clinical features. Clinical data was collected retrospectively on demographic characteristics, presenting signs and symptoms, blood investigation, angiographic findings and in-hospital clinical outcomes. RESULTS The mean age at presentation was 40.2 ± 4.0 years with male predominance (94%). The majority of patients were Chinese (51%) followed by Indians (31%) and Malays (18%). The most common risk factor was smoking (74%) followed by hypertension (28.5%) and hyperlipidemia (20.0%). 37% of patients were obese. The majority of patients had single vessel disease (46%) on coronary angiography. The mean total cholesterol, low-density lipoprotein and high-density lipoprotein levels were 5.6 ± 1.2 mmol/L, 3.8 ± 1.1 mmol/L and 0.93 ± 0.25 mmol/L respectively. The mean left ventricular function was 44% ± 10% with the incidence of heart failure 3% and cardiogenic shock 4.5%. Overall in-hospital mortality was low with 4 deaths (1.2%). For ethnic subgroup analysis, Indians have a 3-fold risk of developing premature AMI when compared to other ethnic groups. CONCLUSION Young AMI patients in Singapore are characterized by male predominance, high incidence of smoking and obesity. Overall in-hospital clinical outcomes are favourable. Among the 3 ethnic groups, Indians have the highest risk of developing premature AMI.
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Affiliation(s)
- Chun Pong Wong
- Chun Pong Wong, Seet Yoong Loh, Kwok Kong Loh, Paul Jau Lueng Ong, David Foo, Hee Hwa Ho, Department of Cardiology, Tan Tock Seng Hospital, Singapore 308433, Singapore
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74
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Ozkan B, Uysal OK, Duran M, Sahin DY, Elbasan Z, Tekin K, Cagliyan CE, Cayli M. Relationship Between Mean Platelet Volume and Atherosclerosis in Young Patients With ST Elevation Myocardial Infarction. Angiology 2012; 64:371-4. [DOI: 10.1177/0003319712448834] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Increased mean platelet volume (MPV) is associated with poor clinical outcome in patients with acute coronary syndrome. We evaluated the predictive role of MPV in young patients with acute myocardial infarction (AMI). This study includes 373 patients who presented to our hospital with AMI (group 1: 134 young patients, males aged <45 years and females aged <55 years; group 2: 239 older patients) and 141 adults with normal coronary angiography as a control group (group 3). In group 1, the levels of MPV and hemoglobin were higher than that in groups 2 and 3. In group 1, blood urea nitrogen levels were lower than that in groups 2 and 3 and creatinine levels were lower than that in group 2. After multivariate analysis, MPV and age were independent predictors of AMI in young patients.
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Affiliation(s)
- Bugra Ozkan
- Department of Cardiology, Burdur Bucak State Hospital, Burdur, Turkey
| | - Onur Kadir Uysal
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Mustafa Duran
- Department of Cardiology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Durmus Yildiray Sahin
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Zafer Elbasan
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Kamuran Tekin
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Caglar Emre Cagliyan
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
| | - Murat Cayli
- Department of Cardiology, Adana Numune Education and Research Hospital, Adana, Turkey
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Goliasch G, Oravec S, Blessberger H, Dostal E, Hoke M, Wojta J, Schillinger M, Huber K, Maurer G, Wiesbauer F. Relative importance of different lipid risk factors for the development of myocardial infarction at a very young age (≤ 40 years of age). Eur J Clin Invest 2012; 42:631-6. [PMID: 22150092 DOI: 10.1111/j.1365-2362.2011.02629.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Low-density lipoprotein (LDL) cholesterol lowering has been established as one of the principal targets in preventive cardiology. Recently, assessment of LDL particle size and number as well as other lipid moieties has been presented as a more reliable method to quantify atherogenicity of the lipoprotein fractions. Thus, it was our aim to assess the influence of different lipoprotein fractions on premature myocardial infarction (≤ 40 years of age). METHODS AND RESULTS We enrolled 302 patients into our multicentre case-control study, including 102 patients with myocardial infarction and 200 age-, gender- and centre-matched controls. The LDL and HDL Lipoprint System were used for lipid subfraction quantification. The lipid risk factors most strongly associated with premature acute myocardial infarction (AMI) in the adjusted model were non-HDL C (OR 5·02, 95% CI 2·75-9·15, P-value = 0·001), LDL-C (OR 4·35, 95% CI 2·5-7·57, P-value = 0·001), VLDL-C (OR 3·66, 95% CI 2·14-6·28, P-value = 0·001), large IDL-C (OR 3·15, 95% CI 1·94-5·12, P-value = 0·001), large LDL-C (OR 3·67, 95% CI 2·19-6·15, P-value = 0·001) and intermediate LDL-C (OR 1·96, 95% CI 1·25-3·06, P-value = 0·003). In contrast, small dense LDL was not significantly associated with premature myocardial infarction. CONCLUSION Non-HDL cholesterol is most strongly associated with premature coronary artery disease and could serve as preferred risk predictor and therapeutic target in this young patient population (≤ 40 years). Besides, VLDL, LDL-C, large LDL, intermediate LDL and large IDL were significantly associated with premature myocardial infarction. Furthermore, our data suggest that risk prediction using small dense LDL particles might not be useful in young AMI survivors.
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Affiliation(s)
- Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Vienna, Austria
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76
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Canpolat U, Yorgun H, Sahiner L, Kabakçi G. Myocardial infarction due to coronary thrombosis in a patient with Henoch-Schönlein purpura. Herz 2012; 37:801-3. [PMID: 22361720 DOI: 10.1007/s00059-012-3597-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2011] [Revised: 01/28/2012] [Accepted: 01/30/2012] [Indexed: 11/28/2022]
Abstract
Henoch-Schönlein purpura (HSP) is characterized by vasculitic involvement of small-sized vessels and results in multisystem manifestations. Cardiac involvement is extremely rare and myocardial infarction with coronary thrombus formation in those patients has also rarely been reported. Herein, we report a 33-year-old man with acute myocardial infarction due to coronary thrombus formation and HSP.
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Affiliation(s)
- U Canpolat
- Department of Cardiology, Hacettepe University Faculty of Medicine, Sıhhiye, 06100, Ankara, Turkey.
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77
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Goliasch G, Wiesbauer F, Kastl SP, Katsaros KM, Blessberger H, Maurer G, Schillinger M, Huber K, Wojta J, Speidl WS. Premature myocardial infarction is associated with low serum levels of Wnt-1. Atherosclerosis 2012; 222:251-6. [PMID: 22391424 DOI: 10.1016/j.atherosclerosis.2012.02.017] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 01/25/2012] [Accepted: 02/10/2012] [Indexed: 01/30/2023]
Abstract
OBJECTIVE Besides its effects on glucose and lipid metabolism, the Wnt pathway has been increasingly implicated in the regulation of proliferation, migration and survival of vascular cells. In addition, defective Wnt signaling has been identified in a family with autosomal dominant early coronary artery disease. The aim of this study was to investigate whether premature coronary artery disease is associated with features of decreased Wnt signaling. METHODS AND RESULTS We prospectively enrolled 100 consecutive young survivors of myocardial infarction (MI≤40 years of age) from two high-volume cardiac catheterization centers and 100 sex and age matched hospital controls. We determined serum levels of Wnt-1 and its antagonist Dkk-1 by ELISA. MI patients showed significantly lower Wnt-1 levels as compared to controls (151 ng/mL, IQR 38-473 ng/mL vs. 233 ng/mL, IQR 62-1756; p<0.005) whereas Dkk-1 was not different at baseline. Wnt-1 levels remained stable over time, whereas Dkk-1 significantly increased at one-year follow-up from 3557, IQR 2306-5810 pg/mL to 4973, IQR 3293-7093 pg/mL (p<0.001). In the stable phase of the disease, Wnt-1 levels were lower (p<0.005) and Dkk-1 levels were significantly higher (p<0.001) as compared to controls. Wnt-1 at follow-up was associated with glucose, HbA1c, non-HDL-, HDL-cholesterol and triglyceride levels but no other features of the metabolic syndrome. CONCLUSION This study establishes an association between low Wnt-1 and high Dkk-1 serum levels and premature myocardial infarction. Wnt-1 is associated with markers of glucose and lipid metabolism. Further research elucidating the role of Wnt pathways in premature coronary artery disease and metabolic syndrome is warranted.
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Affiliation(s)
- Georg Goliasch
- Department of Internal Medicine II, Medical University of Vienna, Austria
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Radak D, Babic S, Peric M, Popov P, Tanaskovic S, Babic D, Jocic D, Otasevic P. Distribution of risk factors in patients with premature coronary, supra-aortic branches and peripheral atherosclerotic disease. Med Princ Pract 2012; 21:228-33. [PMID: 22222608 DOI: 10.1159/000334617] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 10/19/2011] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE The aim of this study was to determine the distribution of major risk factors among patients with atherosclerotic disease aged ≤50 years. SUBJECTS AND METHODS The study population comprised 944 patients aged ≤50 years with clinically significant manifestations of atherosclerotic disease compared with 350 consecutive (control) older patients (age >50 years). RESULTS The most significant risk factors for atherosclerotic disease of the supra-aortic branches were: smoking (87.5%, p < 0.001), family history of atherosclerosis (52.3%, p < 0.001), diabetes mellitus (28.5%) and being male (56.9%) (p < 0.05 for both). In patients with coronary artery disease, there was considerable disparity in the prevalence of smoking (85.4%), hyperlipoproteinemia (67.4%), and family history of atherosclerosis (68%) (p < 0.001). For peripheral artery disease, the most significant risk factors were smoking (97%, p < 0.001), hyperlipidemia (p < 0.01), and family history of atherosclerotic disease (p < 0.01). When compared to controls, patients with premature atherosclerosis smoked more frequently, had hyperlipidemia, had a family history of atherosclerosis, and were more frequently of male sex. CONCLUSION Premature atherosclerosis was most frequently associated with smoking, hyperlipidemia, family history of atherosclerotic disease, and male sex.
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Affiliation(s)
- Djordje Radak
- Department of Vascular Surgery, Institute for Cardiovascular Disease Dedinje, Faculty of Medicine, University of Belgrade, Belgrade, Serbia
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80
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Mulders TA, Meyer Z, van der Donk C, Kroon AA, Ferreira I, Stehouwer CD, Pinto-Sietsma SJ. Patients with premature cardiovascular disease and a positive family history for cardiovascular disease are prone to recurrent events. Int J Cardiol 2011; 153:64-7. [DOI: 10.1016/j.ijcard.2010.08.040] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2010] [Revised: 07/09/2010] [Accepted: 08/07/2010] [Indexed: 11/30/2022]
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81
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Odden MC, Coxson PG, Moran A, Lightwood JM, Goldman L, Bibbins-Domingo K. The impact of the aging population on coronary heart disease in the United States. Am J Med 2011; 124:827-33.e5. [PMID: 21722862 PMCID: PMC3159777 DOI: 10.1016/j.amjmed.2011.04.010] [Citation(s) in RCA: 151] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2010] [Revised: 01/05/2011] [Accepted: 04/04/2011] [Indexed: 11/15/2022]
Abstract
BACKGROUND The demographic shift toward an older population in the United States will result in a higher burden of coronary heart disease, but the increase has not been quantified in detail. We sought to estimate the impact of the aging US population on coronary heart disease. METHODS We used the Coronary Heart Disease Policy Model, a Markov model of the US population between 35 and 84 years of age, and US Census projections to model the age structure of the population between 2010 and 2040. RESULTS Assuming no substantive changes in risks factors or treatments, incident coronary heart disease is projected to increase by approximately 26%, from 981,000 in 2010 to 1,234,000 in 2040, and prevalent coronary heart disease by 47%, from 11.7 million to 17.3 million. Mortality will be affected strongly by the aging population; annual coronary heart disease deaths are projected to increase by 56% over the next 30 years, from 392,000 to 610,000. Coronary heart disease-related health care costs are projected to rise by 41% from $126.2 billion in 2010 to $177.5 billion in 2040 in the United States. It may be possible to offset the increase in disease burden through achievement of Healthy People 2010/2020 objectives or interventions that substantially reduce obesity, blood pressure, or cholesterol levels in the population. CONCLUSIONS Without considerable changes in risk factors or treatments, the aging of the US population will result in a sizeable increase in coronary heart disease incidence, prevalence, mortality, and costs. Health care stakeholders need to plan for the future age-related health care demands of coronary heart disease.
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Affiliation(s)
- Michelle C Odden
- Department of Medicine, University of California, San Francisco, San Francisco, CA 94143-1211, USA.
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82
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Christus T, Shukkur AM, Rashdan I, Koshy T, Alanbaei M, Zubaid M, Hayat N, Alsayegh A. Coronary Artery Disease in Patients Aged 35 or less - A Different Beast? Heart Views 2011; 12:7-11. [PMID: 21731802 PMCID: PMC3123520 DOI: 10.4103/1995-705x.81550] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Aim: To assess the extent and severity of coronary artery disease (CAD) in 200 consecutive patients aged 35 years or less undergoing diagnostic coronary angiography. Patients and Methods: Findings in these 200 patients (≤ 35 years of age) were analyzed to find the extent and severity of CAD. The mean age was 31.69 (±3.76) years. Majority were males (94%) and from the Arab ethnicity (70.5%). Result: Smoking (71%) and history of premature CAD (27%) were the most frequent risk factors (RF). History of previous ST elevation myocardial infarction (MI) was present in 68%. Anterior wall MI was the most frequent location (63.3%). The majority (54.3%) had moderate or large size MI. Ejection fraction (EF) less than 50% was noted in 30.3%. Left main or triple vessel CAD was seen in 15%. One- and two-vessel CAD was seen in 32.5% and 19% patients, respectively. Coronary angiogram was completely normal in 23.5%. The majority (54.5%) were treated conservatively and the rest (45.5%) needed percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The mean number of stents used was 1.3 ± 0.67 and the mean length of stents used was 20.3 ± 12.6 mm. Conclusion: The extent and severity of CAD was very significant in this subgroup of very young (≤35 years) Asian patients. Smoking was the main risk factor and half of the patients needed either PCI or CABG.
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Affiliation(s)
- T Christus
- Department of Cardiology, Chest Diseases Hospital, Ministry of Health, Kuwait
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83
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Abstract
Objective: To evaluate the effect of tobacco smoking on the risk of nonfatal acute myocardial infarction in young adults (≤45 years). Patient and Methods: We conducted a population-based case-control study with 329 incident acute myocardial infarction cases (42 women; 287 men), consecutively admitted to the Cardiology department of hospitals in Aleppo, Syria, and 778 controls (486 women; 292 men), selected within the noninstitutionalized Aleppo population, during 2008-2010. Odds ratios (OR) and 95% confidence intervals (95%CI) were calculated using unconditional logistic regression. Results: The prevalence of current smoking was 80.8% in male cases and 53.8% in male controls (OR = 3.63, 95%CI: 2.50, 5.27) and 59.5% of female cases were smokers compared with 35.8% of controls (OR = 2.64, 95%CI: 1.39, 5.02). No interaction was found between current smoking and gender on myocardial infarction risk (P = 0.401). A dose-effect response was present, the odds favoring myocardial infarction reaching an eight-fold increase for those who smoked >25 cigarettes/day compared with never smokers. The risk estimate for former smokers was similar to never smokers. Conclusions: Tobacco smoking is an important independent risk factor for acute myocardial infarction in young adults, with similar strength of association for both genders.
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Affiliation(s)
- Khaled Hbejan
- Department of Internal Medicine, Faculty of Medicine, Aleppo University, Aleppo University Heart Hospital, Syria
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84
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Chua SK, Hung HF, Shyu KG, Cheng JJ, Chiu CZ, Chang CM, Lin SC, Liou JY, Lo HM, Kuan P, Lee SH. Acute ST-elevation myocardial infarction in young patients: 15 years of experience in a single center. Clin Cardiol 2011; 33:140-8. [PMID: 20235218 DOI: 10.1002/clc.20718] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND There have been few studies done regarding young patients with ST-elevation myocardial infarction (STEMI). The purpose of this study was to investigate the clinical characteristics and coronary angiographic features in young patients with STEMI. METHODS We collected data on 849 consecutive patients with STEMI from 1992 to 2006. Baseline clinical characteristics, coronary anatomy, and outcome were compared in young (< or =45 yrs) and older patients (>45 yrs). RESULTS Young patients presented 11.6% of all patients with STEMI. These patients were predominantly male (92.9% vs 80.3%, P < 0.001), more likely to smoke (75.8% vs 47.2%, P < 0.001), obese (48.2% vs 27.9%, P = 0.002), have higher triglyceride levels (176.9 +/- 153.8 mg/dL vs 140.7 +/- 112.7 mg/dL, P = 0.005), and lower high-density lipoprotein cholesterol (37.1 +/- 7.9 mg/dL vs 42.8 +/- 14.3 mg/dL, P = 0.005) than older patients. Also, younger patients had a shorter hospital stay (7.1 +/- 4.9 d vs 8.5 +/- 6.7 d, P = 0.04), less in-hospital morbidity (29.3% vs 39.7%, P = 0.02), and mortality (3.0% vs 12.3%, P = 0.002). Killip class III or IV could predict in-hospital morbidity and mortality in young patients. Both groups had similar rates of repeated percutaneous coronary intervention (PCI; 45.5% vs 41.5%, P = 0.23) and reinfarction (6.1% vs 3.2%, P = 0.32). Mortality rate during follow-up was significantly lower in younger patients (3.0% vs 19.6%, P < 0.001). CONCLUSION Cigarette smoking, obesity, and dyslipidemia were the most important modifiable risk factors in young patients with STEMI. These patients had a better outcome than older patients without differences in repeated PCI and reinfarction between them. Only Killip class III or IV could predict in-hospital morbidity and mortality in young patients with STEMI.
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Affiliation(s)
- Su-Kiat Chua
- Division of Cardiology, Department of Internal Medicine, Shin Kong Wu Ho-Su Memorial Hospital, No. 95 Wen Chang Road, Taipei, Taiwan
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85
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Alanbaei M, Zubaid M, Al-Mallah MH, Rashed WA, Shehab A, Al-Lawati J, ChB MB, Amin H, Suwaidi JA, Al-Hamdan R, Zubair S. Impact of Diabetes and Smoking Epidemic in the Middle East on the Presentation With Acute Coronary Syndrome in Very Young Patients. Angiology 2011; 63:48-54. [DOI: 10.1177/0003319711406255] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe the baseline characteristics, management, and outcomes of acute coronary syndrome (ACS) in patients of age ≤40 in the Gulf region of the Middle East. We studied 8176 hospitalized patients (≤40 years) with ACS. Ten percent (805) of the recruited patients were ≤40 years. The mean age was 37 years and 89% were males. The prevalence of smoking and diabetes in the young patients was high (58% and 21%, respectively). The most common ACS was ST elevation myocardial infarction. Younger patients were more aggressively treated with more frequent use of glycoprotein inhibitors, thrombolytics, and primary percutaneous coronary intervention. They had less in-hospital heart failure, left ventricular dysfunction, shock, stroke, and low rate of in-hospital mortality (1%). Measures to combat the rising prevalence of diabetes and smoking are needed.
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Affiliation(s)
- Muath Alanbaei
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Mohammad Zubaid
- Department of Medicine, Faculty of Medicine, Kuwait University, Safat, Kuwait
| | - Mouaz H. Al-Mallah
- Wayne State University School of Medicine, Henry Ford Hospital, Detroit, MI, USA
| | - Wafa A Rashed
- Department of Medicine, Mubarak Al-Kabeer Hospital, Ministry of Health, Jabriya, Kuwait
| | | | | | - MB ChB
- Department of Non-communicable Diseases Control, Ministry of Health, Muscat, Oman
| | - Haitham Amin
- Mohammed Bin Khalifa Cardiac Centre, Manama, Bahrain
| | | | - Rashed Al-Hamdan
- Department of Medicine, Jahra Hospital, Ministry of Health, Al-Jahra, Kuwait
| | - Shahid Zubair
- Department of Medicine, Kuwait Oil Company Hospital, Kuwait
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Wang YC, Cheung AM, Bibbins-Domingo K, Prosser LA, Cook NR, Goldman L, Gillman MW. Effectiveness and cost-effectiveness of blood pressure screening in adolescents in the United States. J Pediatr 2011; 158:257-64.e1-7. [PMID: 20850759 PMCID: PMC4007283 DOI: 10.1016/j.jpeds.2010.07.058] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2010] [Revised: 06/18/2010] [Accepted: 07/29/2010] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To compare the long-term effectiveness and cost-effectiveness of 3 approaches to managing elevated blood pressure (BP) in adolescents in the United States: no intervention, "screen-and-treat," and population-wide strategies to lower the entire BP distribution. STUDY DESIGN We used a simulation model to combine several data sources to project the lifetime costs and cardiovascular outcomes for a cohort of 15-year-old U.S. adolescents under different BP approaches and conducted cost-effectiveness analysis. We obtained BP distributions from the National Health and Nutrition Examination Survey 1999-2004 and used childhood-to-adult longitudinal correlation analyses to simulate the tracking of BP. We then used the coronary heart disease policy model to estimate lifetime coronary heart disease events, costs, and quality-adjusted life years (QALY). RESULTS Among screen-and-treat strategies, finding and treating the adolescents at highest risk (eg, left ventricular hypertrophy) was most cost-effective ($18000/QALY [boys] and $47000/QALY [girls]). However, all screen-and-treat strategies were dominated by population-wide strategies such as salt reduction (cost-saving [boys] and $650/QALY [girls]) and increasing physical education ($11000/QALY [boys] and $35000/QALY [girls]). CONCLUSIONS Routine adolescents BP screening is moderately effective, but population-based BP interventions with broader reach could potentially be less costly and more effective for early cardiovascular disease prevention and should be implemented in parallel.
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Affiliation(s)
- Y Claire Wang
- Department of Health Policy and Management, Columbia Mailman School of Public Health, New York, NY, USA
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87
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Acute coronary syndrome in adult patients with coronary artery lesions caused by Kawasaki disease: review of case reports. Cardiol Young 2011; 21:74-82. [PMID: 21070690 DOI: 10.1017/s1047951110001502] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Information about acute coronary syndrome caused by Kawasaki disease-related coronary artery lesions in adults is sketchy. We reviewed the clinical features of 50 adult patients who had an acute coronary syndrome caused by coronary artery lesions due to Kawasaki disease or probable Kawasaki disease from 1980 to 2008. Of the 50 patients, 43 (90%) were male and seven were female (10%). Their ages at the onset of acute coronary syndrome ranged from 18 to 69 years, with a median of 28 years. The culprit lesion in 43 patients was thrombotic occlusion of an aneurysm, and 40 patients had giant aneurysms. In the three patients in whom no aneurysms were seen in coronary angiograms performed at the time of acute myocardial infarction, either giant aneurysms or aneurysms had been visualised in childhood. The initial treatment of acute coronary syndrome was as follows: intracoronary thrombolysis, 11; primary percutaneous coronary intervention, 9; emergency coronary artery bypass grafting, 3; and medication, 26. Elective coronary artery bypass grafting was performed in 15 patients. Three patients (6%) died. Of the 27 patients with additional coronary risk factors, 20 were smokers. Giant aneurysms due to Kawasaki disease continued to cause acute coronary syndrome in adult life with onset at a younger age than typifies that due to atherosclerosis in the general population, especially in male population rather than female population. Even when giant aneurysms regressed after the acute phase, a few patients still developed acute coronary syndrome in adult life. Smoking appears to be the most prominent additional risk factor.
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88
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Primary percutaneous coronary intervention for acute myocardial infarction due to possible sequelae of Kawasaki disease in young adults: a case series. Heart Vessels 2010; 26:117-24. [PMID: 21063878 DOI: 10.1007/s00380-010-0051-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2009] [Accepted: 04/09/2010] [Indexed: 10/18/2022]
Abstract
Experience of primary percutaneous coronary intervention (PCI) for young adults with acute myocardial infarction (AMI) due to sequelae of Kawasaki disease (KD) has been extremely limited. In the present report on three young adults (two males and one female; age 20-35 years) with AMI, we performed primary PCI and intravascular ultrasound imaging (IVUS). Case 1 underwent thrombectomy alone in the proximal left circumflex coronary artery, and subsequent IVUS depicted a large aneurysm with an asymmetrically intimal thickening and a residual thrombus in the culprit. Case 2 underwent balloon dilation with adjunctive intracoronary thrombolysis in the proximal left anterior descending coronary artery (LAD), and IVUS during follow-up coronary angiography (CAG) delineated a regressed giant aneurysm with a markedly intimal thickening in the culprit. Case 3, with past history highly suggesting KD, underwent balloon dilation in the proximal LAD, and follow-up CAG as well as IVUS revealed a neoaneurysmal formation in the culprit. In all of the patients, PCI was angiographically effective at the acute phase without complication. Follow-up CAG performed 3-6 months after the procedure revealed no restenosis in all three cases, but a new coronary aneurysm still remained in case 3. Although case 1 and case 2 had no obvious history of KD, the vessel wall morphology from IVUS closely resembled the coronary sequelae after KD, suggesting that they might have antecedent incomplete KD. These cases suggest that primary PCI against coronary sequelae of KD in young AMI patients might be safe and effective in the short term.
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89
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Chen SM, Tsai TH, Hang CL, Yip HK, Fang CY, Wu CJ, Guo GBF. Endothelial dysfunction in young patients with acute ST-elevation myocardial infarction. Heart Vessels 2010; 26:2-9. [DOI: 10.1007/s00380-010-0017-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Accepted: 01/12/2010] [Indexed: 11/24/2022]
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90
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Pineda J, Marín F, Marco P, Roldán V, Valencia J, Ruiz-Nodar JM, Romero DH, Sogorb F, Lip GY. The prognostic value of biomarkers after a premature myocardial infarction. Int J Cardiol 2010; 143:249-54. [DOI: 10.1016/j.ijcard.2009.02.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2008] [Revised: 02/14/2009] [Accepted: 02/19/2009] [Indexed: 11/28/2022]
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91
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Adult rats are more sensitive to the vascular effects induced by hyperhomocysteinemia than young rats. Vascul Pharmacol 2010; 53:99-106. [DOI: 10.1016/j.vph.2010.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2009] [Revised: 04/19/2010] [Accepted: 04/22/2010] [Indexed: 11/18/2022]
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92
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Barrios V, Escobar C, Murga N, Quijano JJ. Clinical profile and management of patients with chronic ischemic heart disease according to age in the population daily attended by cardiologists in Spain The ELDERCIC study. Eur J Intern Med 2010; 21:180-4. [PMID: 20493419 DOI: 10.1016/j.ejim.2010.01.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2009] [Revised: 12/10/2009] [Accepted: 01/11/2010] [Indexed: 11/18/2022]
Abstract
OBJECTIVES This study was aimed to evaluate the differences according to age in the clinical profile and management of outpatients with chronic ischemic heart disease attended by cardiologists in Spain. METHODS Patients with an established diagnosis of chronic ischemic heart disease were included in this cross-sectional multicenter study. The age of 65 years was considered as the cut-off point for the present analysis. RESULTS A total of 1038 subjects were included, 524 of them (50.5%) >65 years. Patients >65 years had a lesser prevalence of smoking, a longer history of hypertension, a worse left ventricular ejection fraction and a higher prevalence of heart failure and renal insufficiency than younger subjects. The number of prescribed drugs was higher in patients >65 years (6.1+/-1.9 vs 5.7+/-2.1, p=0.004). Blood pressure control rate was lower in older patients (38.1% vs 46.5%, p=0.008). No significant differences were found either in LDL-cholesterol (42.4% vs 46.5%), or glycemic control rates (42.4% vs 41.4%), both p=NS. Diagnostic and therapeutic procedures were also compared in >65 vs < or =65 years, exercise test was performed in 51.5% vs 62.8% (p<0.0001); stress echocardiography in 18.3% vs 13.2% (p=0.027); coronary angiography in 38.6% vs 53.5% (p<0.0001); and coronary revascularization in 37.2% vs 46.9% (p=0.002), without significant differences in electrocardiogram, echocardiogram, or isotopic exams. CONCLUSIONS Older patients exhibited a worse clinical profile and a worse blood pressure control rate than the younger. However, diagnostic and therapeutic procedures appear to be frequently underused in the old patients.
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Affiliation(s)
- Vivencio Barrios
- Vivencio Barrios, Dept. of Cardiology, Hospital Ramón y Cajal, Ctra. Colmenar km 9.100, 28034 Madrid, Spain.
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93
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Meenakshisundaram R, Agarwal D, Rajendiran C, Thirumalaikolundusubramanian P. Risk factors for myocardial infarction among low socioeconomic status South Indian population. Diabetol Metab Syndr 2010; 2:32. [PMID: 20500893 PMCID: PMC2890541 DOI: 10.1186/1758-5996-2-32] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 05/26/2010] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND As longevity increases, cases of myocardial infarction (MI) are likely to be more. Cardiovascular disease (CVD) is a major global health problem reaching epidemic proportions in the Indian subcontinent, also among low socio-economic status (SES) and thin individuals. OBJECTIVES The present study was undertaken to elicit risk factors for MI among low SES Southern Indians and to find out its association with body mass index (BMI). MATERIALS AND METHODS A case-control study of patients with MI matched against healthy control subjects was carried out in a tertiary care teaching hospital. Standard methods were followed to elicit risk factors and BMI. Chi-square and Fishers exact test for categorical versus categorical, to show relationship with risk factors were analyzed. RESULTS A total of 949 patients (male (M) = 692 and post menopausal female (F) = 257) and 611 age and sex matched healthy controls were included. In our study, BMI was below 23 in 48.2% of patients and below 21 in 22.5%. The risk of developing MI was significantly more in males (odds ratio (OR) = 3.3, 95% confidence interval (C.I.) = 2.69-4.13), among females with post-menopausal duration (PMD) of more than or equal to 3 years (OR = 9.27, 95% C.I. = 6.36-13.50) and in those with BMI less than 23 with one or other risk factors (P = 0.002, OR = 1.38, 95% C.I. = 1.13-1.70). CONCLUSION BMI cannot be considered as a lone independent risk factor, as the study population had low BMI but had one or more modifiable risk factors. It would be advisable to keep BMI at least 21 kg/m2 for screening program. Health education on life style modification and programs to diagnose and control diabetes and hypertension have to be initiated at community level in order to reduce the occurrence.
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94
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Chen JH, Tseng CL, Tsai SH, Chiu WT. Initial serum glucose level and white blood cell predict ventricular arrhythmia after first acute myocardial infarction. Am J Emerg Med 2010; 28:418-23. [DOI: 10.1016/j.ajem.2008.12.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2008] [Revised: 12/24/2008] [Accepted: 12/25/2008] [Indexed: 01/08/2023] Open
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Abstract
PURPOSE Combined coronary artery bypass (CAB) and valve surgery is one of the most challenging surgical procedures, but the operative results have improved over the years. MATERIALS AND METHODS From 1989 through 2004, combined CAB and valve operations were performed in 125 patients. Mean age was 63 years, and 86 patients were male. Forty-six patients were diagnosed with coronary artery disease during preoperative evaluation for valvular heart disease (VHD). All patients underwent CAB, and one or more underwent valve replacement or repair (mitral: 54, aortic: 61, tricuspid: 3, DVR: 7) simultaneously. RESULTS Mean number of distal graft was 1.98 +/- 1.07, and LIMA was used in 68% of patients. Early mortality occurred in 6 patients (4.8%), and the causes were heart failure (4) and sepsis (2). Mean follow-up duration was 91.4 +/- 40.9 months (range: 47-245), and late mortality occurred in 4 patients. Kaplan Meier estimated survival rates at 1, 5, and 10 years were 94.4 %, 92.3%, and 89.9%, respectively. CONCLUSION Combined coronary and valve operations can be performed safely with optimal surgical results. Although the surgical mortality of coexisting coronary and VHD is higher than either isolated coronary or valvular operations, it may not affect the long-term survival.
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Affiliation(s)
- Sak Lee
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Byung-Chul Chang
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kyung-Jong Yoo
- Department of Thoracic and Cardiovascular Surgery, Yonsei Cardiovascular Research Institute, Yonsei University College of Medicine, Seoul, Korea
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Guodong Jin, Beili Feng, Peng Chen, Oushan Tang, Jian Wang, Ji Ma, Yuping Shi, Geng Xu. Coagulation factor XIII-A Val34Leu polymorphism and the risk of coronary artery disease and myocardial infarction in a Chinese Han population. Clin Appl Thromb Hemost 2010; 17:208-13. [PMID: 20211923 DOI: 10.1177/1076029609355152] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
There are controversial data regarding the impact of coagulation factor XIII A subunit (FXIII-A) Val34Leu polymorphism in the pathogeneric of coronary artery disease (CAD) and myocardial infarction (MI). Assuming this genetic factor is associated with the thrombotic process, we explored the role of FXIII-A Val34Leu in CAD and MI in a Chinese Han population. We recruited 195 consecutive patients with CAD confirmed by coronary angiography as well as a group of 203 controls. Factor XIII A Val34Leu polymorphism was determined through polymerase chain reaction-single strand conformational polymorphism (PCR-SSCP) analysis. We did not find the Leu/Leu genotype in patients with CAD or controls. No significant difference in Val34Leu gene polymorphism distribution was found between patients with CAD and the controls (P = .923). Subgroup analysis according to the history of MI showed the heterozygote Val/Leu genotype was associated with a significantly decreased risk of MI (P = .005; adjusted odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.28-2.25). Furthermore, our study displayed that the frequency of the Leu34 allele in a Chinese Han population was lower than that in Caucasian populations (2.5 vs 20.4%-28.3%). Our preliminary data indicate that the FXIII-A Leu34 allele may contribute to a protective effect against the development of MI. There is a low prevalence of the Leu34 allele in Han Chinese compared to Caucasians.
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Affiliation(s)
- Guodong Jin
- Department of Cardiology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
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97
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Comparison of outcomes in young versus nonyoung patients with ST elevation myocardial infarction treated by primary angioplasty. Coron Artery Dis 2010; 21:72-7. [DOI: 10.1097/mca.0b013e328334a0f6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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98
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Jones ID, Slovis CM. Pitfalls in Evaluating the Low-Risk Chest Pain Patient. Emerg Med Clin North Am 2010; 28:183-201, ix. [DOI: 10.1016/j.emc.2009.10.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
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99
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A young soldier with syncope, shortness of breath and palpitations. VOJNOSANIT PREGL 2010; 67:681-4. [DOI: 10.2298/vsp1008681m] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Introduction. Coronary artery disease in people under 30 years is relatively uncommon, but once a disease occurs it brings a significant morbidity and psychological effects. Case report. We reported a 28-year-old patient presenting atypical symptoms after sincopa and non-specific changes on electrocardiogram at admission. After noninvasive and invasive cardiology diagnostic procedures were made, we concluded that he had a subtotal tubular stenosis in proximal segment of the left anterior descending coronary artery. Myocardial revascularization was successfully performed 24-hour after coronarography with the left internal mammary thoracic artery graft on the left anterior descending coronary artery and the patient had a prompt and satisfactory postoperative recovery. Conclusion. This case indicates the importance of a careful evaluation of young adults even if they do not experience typical anginal symptoms or do not have multiple risk factors for cardiovascular diseases.
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100
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Acute myocardial infarction in a young woman. COR ET VASA 2009. [DOI: 10.33678/cor.2009.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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