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Kassam N, Ngunga M, Varwani M, Msunza M, Jeilan M. Acute coronary syndrome patterns in the Young: risk factor profile and in-hospital outcomes in a tertiary referral hospital in Kenya. BMC Cardiovasc Disord 2024; 24:192. [PMID: 38570757 PMCID: PMC10988889 DOI: 10.1186/s12872-024-03832-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/07/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Acute coronary syndrome (ACS) accounts for coronary artery disease (CAD) -related morbidity and mortality. There has been growing concern about the rising incidence of ACS among young individuals globally both in developed and developing countries, including Sub-Saharan Africa. This group's phenotypic characteristics; risk factors and clinical outcomes are not well described. contextual and regional studies are necessary to understand the magnitude of ACS among young Individuals and help highlight challenges and opportunities for improved ACS outcomes in the region. The study aimed to describe the demographic and clinical characteristics of young individuals hospitalized with ACS and report on in-hospital outcomes. METHODOLOGY This single-center retrospective study was conducted at the Aga Khan University Hospital, Nairobi. Medical records of all young individuals hospitalized with ACS from 30th June 2020 to 1st May 2023 were reviewed. We defined young individuals as 50 years or below. Categorical variables were reported as frequencies and proportions, and compared with Pearson chi- square or Fisher's exact tests. Continuous variables were reported as means or medians and compared with independent t-tests or Mann-Whitney U tests. P- value < 0.05 was considered statistically significant. RESULTS Among 506 patients hospitalized with ACS, (n = 138,27.2%) were aged 50 years and below. The study population was male (n = 107, 79.9%) and African(n = 82,61.2%) predominant with a median age of 46.5 years (IQR 41.0-50.0). Hypertension (n = 101,75.4%) was noted in most study participants. More than half of the cohort were smokers (n = 69,51.5%) having a family history of premature ASCVD(n = 70,52.2%) and were on lipid-lowering therapy(n = 68,50.7%) prior to presentation. ST-segment-elevation myocardial infarction (STEMI) was the most common clinical manifestation of ACS (n = 77, 57.5%). Of the significant coronary artery disease (n = 75,56.0%), the majority of the individuals had single vessel disease (n = 60, 80%) with a predilection of left anterior deciding artery(n = 47,62.6%). The Main cause of ACS was atherosclerosis (n = 41,54.6%). The mean left ventricular ejection fraction was 46.0 (± 12.4). The in-hospital mortality was (n = 2, 1.5%). CONCLUSION This study highlights that young individuals contribute to a relatively large proportion of patients presenting with ACS at our center. The most common presentation was STEMI. The principal cause was atherosclerosis. The findings of this study highlight the importance of developing systems of care that enable the early detection of CAD. Traditional cardiovascular risk factors were prevalent and modifiable, thus targets of intervention.
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Affiliation(s)
- Nadeem Kassam
- Department of cardiology, Aga Khan University Kenya, P.O. Box 30270 - 00100, Nairobi, Kenya.
| | - Mzee Ngunga
- Department of cardiology, Aga Khan University Kenya, P.O. Box 30270 - 00100, Nairobi, Kenya
| | - Mohamed Varwani
- Department of cardiology, Aga Khan University Kenya, P.O. Box 30270 - 00100, Nairobi, Kenya
| | - Miriam Msunza
- Department of cardiology, Aga Khan University Kenya, P.O. Box 30270 - 00100, Nairobi, Kenya
| | - Mohamed Jeilan
- Department of cardiology, Aga Khan University Kenya, P.O. Box 30270 - 00100, Nairobi, Kenya
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Goulden CJ. Percutaneous coronary intervention versus coronary artery by-pass grafting in premature coronary artery disease: What is the evidence? -A narrative review. Perfusion 2023:2676591231223356. [PMID: 38108274 DOI: 10.1177/02676591231223356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2023]
Abstract
Coronary artery disease (CAD) remains one of the leading causes of death globally. In the United States of America, in 2016, 19% of all patients under the age of 65 died of cardiovascular disease despite improvements in primary prevention. The premature clinical onset of symptoms in the young population (<60 years) is much more aggressive than in the older population, and the overall long-term prognosis is poor. CAD appears to have a rapidly progressive form in those under the age of 60 due to genetic predisposition, smoking, and substance abuse, however, the ideal management strategy is still yet to be established. The two primary methods of establishing coronary revascularization are percutaneous coronary intervention (PCI) and coronary artery bypass graft (CABG). Despite the increasing prevalence of CAD in the young population, they are consistently underrepresented in major randomized clinical trials of each revascularization strategy. Both CABG and PCI are known to have similar survival rates, but PCI is associated with higher repeat revascularization rate. Many argue this may be due to the progressive nature of CAD combined with the vessel patency time required in a patient under 60 with potentially another 20-30 years of life. There is little in literature regarding the outcomes of these various revascularization strategies in populations under 60 years with CAD. This review summarises the current evidence for each revascularisation strategy in patients under the age of 60 and suggests future avenues of research for this unique age group.
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Ando H, Yamaji K, Kohsaka S, Ishii H, Sakakura K, Goto R, Nakano Y, Takashima H, Ikari Y, Amano T. Clinical Presentation and In-Hospital Outcomes of Acute Myocardial Infarction in Young Patients: Japanese Nationwide Registry. JACC. ASIA 2022; 2:574-585. [PMID: 36518720 PMCID: PMC9743453 DOI: 10.1016/j.jacasi.2022.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 03/11/2022] [Accepted: 03/27/2022] [Indexed: 01/11/2023]
Abstract
Background Acute myocardial infarction (AMI) in young patients is a concerning issue because of its adverse health and social impacts. Nevertheless, risk factors and prognosis of AMI in young patients are yet to be characterized. Objectives This study aimed to characterize AMI in young patients who underwent primary percutaneous coronary intervention (PCI) using large-scale nationwide all-comer registry data in Japan, the Japanese Percutaneous Coronary Intervention (J-PCI). Methods This retrospective cohort study evaluated the J-PCI registry data of patients with AMI aged 20 to 79 years who underwent primary PCI between January 2014 and December 2018. Data on risk factor profiles, clinical features, post-procedural complications, and in-hospital outcomes were reviewed. Results Among 213,297 patients with AMI who underwent primary PCI, 23,985 (11.2%) were young (ages 20 to 49 years). Compared with the older group (ages 50 to 79 years; n = 189,312), the younger group included a higher number of men, smokers, patients with dyslipidemia, and patients with single-vessel disease, and a lower number of patients with hypertension and diabetes. Despite favorable clinical profiles, younger age was associated with a higher rate of presentation with cardiopulmonary arrest (CPA). Further, concomitant CPA was strongly associated with in-hospital mortality in young patients (odds ratio: 14.2; 95% CI: 9.2 - 21.9). Conclusions Younger patients with AMI presented a higher risk of CPA, which was strongly associated with in-hospital mortality. The results of this study highlight the importance of primary AMI prevention strategies in young individuals.
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Affiliation(s)
- Hirohiko Ando
- Department of Cardiology, Aichi Medical University, Nagakute, Japan,Address for correspondence: Dr Hirohiko Ando, Department of Cardiology, Aichi Medical University, 1-1 Yazakokarimata, Nagakute 480-1195, Japan.
| | - Kyohei Yamaji
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shun Kohsaka
- Department of Cardiology, Keio University School of Medicine, Tokyo, Japan
| | - Hideki Ishii
- Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Saitama, Japan
| | - Reiji Goto
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | - Yusuke Nakano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
| | | | - Yuji Ikari
- Department of Cardiology, Tokai University, Isehara, Japan
| | - Tetsuya Amano
- Department of Cardiology, Aichi Medical University, Nagakute, Japan
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Causes, Angiographic Characteristics, and Management of Premature Myocardial Infarction: JACC State-of-the-Art Review. J Am Coll Cardiol 2022; 79:2431-2449. [PMID: 35710195 DOI: 10.1016/j.jacc.2022.04.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/31/2022] [Accepted: 04/13/2022] [Indexed: 12/13/2022]
Abstract
Among patients presenting with acute myocardial infarction (AMI), the proportion of young individuals has increased in recent years. Although coronary atherosclerosis is less extensive in young patients with AMI, with higher prevalence of single-vessel disease and rare left main involvement, the long-term prognosis is not benign. Young patients with AMI with obstructive coronary artery disease have similar risk factors as older patients except for higher prevalence of smoking, lipid disorders, and family history of premature coronary artery disease, and lower prevalence of diabetes mellitus and hypertension. Smoking cessation is by far the most effective secondary preventive measure. Myocardial infarction with nonobstructive coronary arteries is a relatively common clinical entity (10%-20%) among young patients with AMI, with intravascular and cardiac magnetic resonance imaging being key for diagnosis and potentially treatment. Spontaneous coronary artery dissection is a frequent pathogenetic mechanism of AMI among young women, requiring a high degree of suspicion, especially in the peripartum period.
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Smith M, Orchard J, La Gerche A, Gallagher R, Fitzpatrick J. Fit, Female or Fifty–Is Cardiac Rehabilitation “Fit” for Purpose for All? A Systematic Review and Meta-Analysis With Meta-Regression. Front Cardiovasc Med 2022; 9:764882. [PMID: 35425816 PMCID: PMC9001939 DOI: 10.3389/fcvm.2022.764882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
AimsCardiac rehabilitation (CR) is an evidence-based intervention promoting risk factor modification following coronary artery disease events but the relative benefits for patient subgroups is not clear. This review synthesizes the available evidence on the effectiveness of modern CR programs and determines outcomes for age, sex and prior level of fitness.MethodsMEDLINE, CINAHL, and EMBASE were examined for RCT and cohort studies involving exercise prescription or phase II or III CR following Myocardial Infarction (MI), Percutaneous Coronary Intervention (PCI) and cardiac surgery from January 2010 to February 2021. Outcomes assessed included peakVO2max, 6-min walk test and Metabolic Equivalent of Task. Meta-regression was used to determine CR impact for change in fitness and age and sex influences.ResultsThe mean age of study participants was 59.5 years and 82.7% were male. Females, younger people and those of average or above cardiorespiratory fitness were substantially under-represented in data and attendance, with 13% of study groups with a mean age <55 years. At entry, 73% were below average for fitness vs. age-matched normative values. Fitness improved across all groups following CR with no evidence of sex or age independently affecting outcomes.ConclusionsModest improvements in fitness in all groups were shown, but the benefits of CR can be far greater. A modern, innovative approach to CR will likely lead to more substantial benefits. This may require a “Precision Medicine” model which tailors exercise prescription to different populations to ensure all CR participant's needs are met. This will ensure that CR is more flexible and accessible for all.
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Affiliation(s)
- Martin Smith
- Australasian College of Sport and Exercise Physicians, Melbourne, VIC, Australia
- *Correspondence: Martin Smith
| | - Jessica Orchard
- Agnes Ginges Centre for Molecular Cardiology, Centenary Institute and The University of Sydney, Sydney, NSW, Australia
| | - Andre La Gerche
- Clinical Research Department, Baker Heart and Diabetes Institute, Melbourne, VIC, Australia
| | - Robyn Gallagher
- Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Jane Fitzpatrick
- Department of Physiotherapy, Centre for Health, Exercise and Sports Medicine, Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Carlton, VIC, Australia
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Rizk T, Blankstein R. Not All Heart Attacks are Created Equal: Thinking Differently About Acute Myocardial Infarction in the Young. Methodist Debakey Cardiovasc J 2021; 17:60-67. [PMID: 34824682 PMCID: PMC8588727 DOI: 10.14797/mdcvj.345] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Accepted: 07/13/2021] [Indexed: 11/24/2022] Open
Abstract
Cardiovascular disease, particularly myocardial infarction, remains a major cause of morbidity and mortality among young individuals. Although myocardial infarctions have declined significantly in the general population, this decline has not been uniformly observed in younger cohorts. Young adults often have different risk factors, including a higher burden of tobacco use and substance abuse, and they are less likely to be treated with preventive therapies since they are often categorized as having low risk. This review examines the existing literature on myocardial infarction in young patients, with a focus on risk factors, therapeutic challenges, and opportunities for prevention.
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Affiliation(s)
- Theresa Rizk
- Duke University School of Medicine, Durham, North Carolina, US.,Brigham and Women's Hospital, Brookline, Massachusetts, US
| | - Ron Blankstein
- Brigham and Women's Hospital, Brookline, Massachusetts, US.,Harvard Medical School, Cambridge, Massachusetts, US
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Lorca R, Pascual I, Aparicio A, Junco-Vicente A, Alvarez-Velasco R, Barja N, Roces L, Suárez-Cuervo A, Diaz R, Moris C, Hernandez-Vaquero D, Avanzas P. Premature STEMI in Men and Women: Current Clinical Features and Improvements in Management and Prognosis. J Clin Med 2021; 10:jcm10061314. [PMID: 33806738 PMCID: PMC8004961 DOI: 10.3390/jcm10061314] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Revised: 03/15/2021] [Accepted: 03/17/2021] [Indexed: 12/12/2022] Open
Abstract
Background: Coronary artery disease (CAD) is the most frequent cause of ST-segment elevation myocardial infarction (STEMI). Etiopathogenic and prognostic characteristics in young patients may differ from older patients and young women may present worse outcomes than men. We aimed to evaluate the clinical characteristics and prognosis of men and women with premature STEMI. METHODS A total 1404 consecutive patients were referred to our institution for emergency cardiac catheterization due to STEMI suspicion (1 January 2014-31 December 2018). Patients with confirmed premature (<55 years old in men and <60 in women) STEMI (366 patients, 83% men and 17% women) were included (359 atherothrombotic and 7 spontaneous coronary artery dissection (SCAD)). RESULTS Premature STEMI patients had a high prevalence of classical cardiovascular risk factors. Mean follow-up was 4.1 years (±1.75 SD). Mortality rates, re-hospitalization, and hospital stay showed no significant differences between sexes. More than 10% of women with premature STEMI suffered SCAD. There were no significant differences between sexes, neither among cholesterol levels nor in hypolipemiant therapy. The global survival rates were similar to that expected in the general population of the same sex and age in our region with a significantly higher excess of mortality at 6 years among men compared with the general population. CONCLUSION Our results showed a high incidence of cardiovascular risk factors, a high prevalence of SCAD among young women, and a generally good prognosis after standardized treatment. During follow-up, 23% suffered a major cardiovascular event (MACE), without significant differences between sexes and observed survival at 1, 3, and 6 years of follow-up was 96.57% (95% CI 94.04-98.04), 95.64% (95% CI 92.87-97.35), and 94.5% (95% CI 91.12-97.66). An extra effort to prevent/delay STEMI should be invested focusing on smoking avoidance and optimal hypolipemiant treatment both in primary and secondary prevention.
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Affiliation(s)
- Rebeca Lorca
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Isaac Pascual
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
- Correspondence:
| | - Andrea Aparicio
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Alejandro Junco-Vicente
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Rut Alvarez-Velasco
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Noemi Barja
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Luis Roces
- Anestesiología, Reanimación y Terapéutica del Dolor, Completo Asistencial Universitario de Salamanca, 37007 Salamanca, Spain;
| | - Alfonso Suárez-Cuervo
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
| | - Rocio Diaz
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Cesar Moris
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Daniel Hernandez-Vaquero
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
| | - Pablo Avanzas
- Heart Area, Hospital Universitario Central de Asturias, 33011 Oviedo, Spain; (R.L.); (A.A.); (A.J.-V.); (R.A.-V.); (N.B.); (A.S.-C.); (R.D.); (C.M.); (D.H.-V.); (P.A.)
- Instituto de Investigación Sanitaria del Princpado de Asturias, ISPA, 33011 Oviedo, Spain
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Yanase T, Sakakura K, Taniguchi Y, Yamamoto K, Tsukui T, Seguchi M, Wada H, Momomura SI, Fujita H. Comparison of Clinical Characteristics of Acute Myocardial Infarction Between Young (< 55 Years) and Older (55 to < 70 Years) Patients. Int Heart J 2021; 62:33-41. [PMID: 33518663 DOI: 10.1536/ihj.20-444] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Although the incidence of acute myocardial infarction (AMI) has been decreasing in the elderly, it has been increasing in the young, especially in Japan. A social impact of AMI would be greater in the young, because loss of the young directly influences social activities such as business, child-raising, and tax payment. The aim of this study was to identify the specific characteristics of young AMI patients. We retrospectively included 408 consecutive AMI patients < 70 years of age, divided into a young group (< 55 years: n = 136) and an older group (55 to < 70 years: n = 272). The prevalence of overweight was greater in the young group (58.5%) than in the older group (40.7%) (P = 0.001). The frequency of current smokers was higher in the young group (67.6%) than in the older group (44.9%) (P < 0.001). Although the prevalence of hypertension was lower in the young group (66.7%) than in the older group (77.2%) (P = 0.017), that of untreated hypertension was greater in the young group (40.4%) than in the older group (27.2%) (P = 0.007). Furthermore, the prevalence of untreated dyslipidemia was greater in the young group (45.0%) than in the older group (26.6%) (P < 0.001). In conclusion, the young AMI patients had more modifiable risk factors such as obesity, smoking, untreated hypertension, and untreated dyslipidemia than the older patients. There is an unmet medical need for the prevention of AMI in the young generation.
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Affiliation(s)
- Tomonobu Yanase
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kenichi Sakakura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Yousuke Taniguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Kei Yamamoto
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Takunori Tsukui
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Masaru Seguchi
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hiroshi Wada
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Shin-Ichi Momomura
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
| | - Hideo Fujita
- Division of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University
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Jamil S, Jamil G, Mesameh H, Qureshi A, AlKaabi J, Sharma C, Aziz F, Al-Shamsi AR, Yasin J. Risk factor comparison in young patients presenting with acute coronary syndrome with atherosclerotic coronary artery disease vs. angiographically normal coronaries. Int J Med Sci 2021; 18:3526-3532. [PMID: 34522179 PMCID: PMC8436094 DOI: 10.7150/ijms.60869] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/07/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Acute myocardial infarction is a relatively rare phenomenon in the young population. The incidence has nevertheless increased from years past, likely due to the presence of multiple risk factors from an increasingly younger age. Regardless of whether they have atherosclerotic coronary artery disease or normal coronary angiogram, young patients with risk factors for coronary artery disease (CAD), chest pain, and positive troponin, are initially treated in a similar fashion. Our goal was to shed light on whether risk factors between these two groups differ to help guide physicians in clinically determining whether or not an atherosclerotic cardiovascular event has occurred, as well as to potentially identify young patients at risk of acute coronary syndrome (ACS) despite normal coronary arteries. Methods: A retrospective cross sectional study was undertaken over an 8 year period at Tawam Hospital. 576 patients aged 50 or under who underwent coronary angiography were selected for the study. Medical records were analyzed for the patient's demographics and CAD risk factor profile, including the following variables: family history of CAD, smoking status, Body Mass Index category, lipid profile, and diagnosis of hyperlipidemia, diabetes, or hypertension. Details of the coronary angiogram were also reviewed. Results: Statistically significant outcomes included a higher prevalence of diabetes, hyperlipidemia, and smoking history in patients with CAD compared to the patients with normal coronary angiogram. Diabetes was one of the strongest risk factors in CAD patients, with an odds ratio of 1.98 (p= 0.011), followed by hyperlipidemia at 1.85 (p= 0.021). Smoking history had an odds ratio of 2.93 (p <0.001). Conclusion: Risk factors were present in both groups, but significantly more in the CAD group. No particular risk factor stood out for the development of ACS in those with normal coronary arteries, other than mean BMI being slightly higher in this group. Based on our analysis, no single variable can accurately predict the risk for ACS in normal coronaries. To our knowledge, few studies have been done in the young population with angiographically normal coronary arteries to determine possible risk factors for development of ACS. Further research needs to be done to determine whether the risk factors that were common amongst both groups are coincidental, or a cause of ACS in those with normal coronary arteries.
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Affiliation(s)
- Sarah Jamil
- Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Gohar Jamil
- Department of Cardiology, Tawam Hospital, Al Ain, United Arab Emirates.,Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hanaa Mesameh
- Nursing, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Juma AlKaabi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Charu Sharma
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | | | - Javed Yasin
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Ajitkumar J, Varun N. Clinical and angiographic profile of acute coronary syndrome patients (<40 years) and short-term prognosis: A cross-sectional study. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2021. [DOI: 10.4103/jpcs.jpcs_58_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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11
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Stein NR, Ramakrishna S, Yeghiazarians Y. Premature coronary disease, in-stent restenosis and vascular complications in a young man with Behçet syndrome. BMJ Case Rep 2020; 13:e235039. [PMID: 32843407 PMCID: PMC7449362 DOI: 10.1136/bcr-2020-235039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2020] [Indexed: 11/03/2022] Open
Abstract
A young man with a history of early-onset coronary disease presented with an ST-elevation myocardial infarction at the age of 38. He subsequently had recurrent in-stent restenosis requiring repeating interventions and ultimately bypass surgery. After 4 years, he presents with systemic symptoms, new skin lesions and a femoral artery pseudoaneurysm. He is diagnosed with Behçet syndrome, a rare systemic vasculitis characterised by the triad of oral aphthous ulcers, genital ulcers and ocular involvement. Behçet is not associated with premature coronary disease but can have a variety of cardiac complications. Additionally, pathergy, an exaggerated inflammatory response to local injury, is characteristic. We hypothesise that in retrospect, subclinical inflammation and a vascular pathergy likely predisposed him to his cardiac and vascular complications. Here, we review risk factors and presentation of premature coronary artery disease and review the literature on the cardiovascular complications of Behçet syndrome.
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Affiliation(s)
- Nathan R Stein
- Department of Internal Medicine, University of California San Francisco, San Francisco, California, USA
| | - Satvik Ramakrishna
- Department of Internal Medicine, Division of Cardiology, University of California San Francisco, San Francisco, California, USA
| | - Yerem Yeghiazarians
- Department of Internal Medicine, Division of Cardiology, University of California San Francisco, San Francisco, California, USA
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Divakaran S, Singh A, Biery D, Yang J, DeFilippis EM, Collins BL, Ramsis M, Qamar A, Hainer J, Klein J, Cannon CP, Polk DM, Plutzky J, Nasir K, Januzzi JL, Di Carli MF, Bhatt DL, Blankstein R. Diabetes Is Associated With Worse Long-term Outcomes in Young Adults After Myocardial Infarction: The Partners YOUNG-MI Registry. Diabetes Care 2020; 43:1843-1850. [PMID: 31548242 PMCID: PMC7372040 DOI: 10.2337/dc19-0998] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 08/27/2019] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We sought to determine the prevalence of diabetes and associated cardiovascular outcomes in a contemporary cohort of young individuals presenting with their first myocardial infarction (MI) at age ≤50 years. RESEARCH DESIGN AND METHODS We retrospectively analyzed records of patients presenting with a first type 1 MI at age ≤50 years from 2000 to 2016. Diabetes was defined as a hemoglobin A1c ≥6.5% (48 mmol/mol) or a documented diagnosis of or treatment for diabetes. Vital status was ascertained for all patients, and cause of death was adjudicated. RESULTS Among 2,097 young patients who had a type 1 MI (mean age 44.0 ± 5.1 years, 19.3% female, 73% white), diabetes was present in 416 (20%), of whom 172 (41%) were receiving insulin. Over a median follow-up of 11.2 years (interquartile range 7.3-14.2 years), diabetes was associated with a higher all-cause mortality (hazard ratio 2.30; P < 0.001) and cardiovascular mortality (2.68; P < 0.001). These associations persisted after adjusting for baseline covariates (all-cause mortality: 1.65; P = 0.008; cardiovascular mortality: 2.10; P = 0.004). CONCLUSIONS Diabetes was present in 20% of patients who presented with their first MI at age ≤50 years and was associated with worse long-term all-cause and cardiovascular mortality. These findings highlight the need for implementing more aggressive therapies aimed at preventing future adverse cardiovascular events in this population.
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Affiliation(s)
- Sanjay Divakaran
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Avinainder Singh
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - David Biery
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Junjie Yang
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ersilia M DeFilippis
- Department of Medicine, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Bradley L Collins
- Department of Medicine, New York Presbyterian-Columbia University Irving Medical Center, New York, NY
| | - Mattheus Ramsis
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Arman Qamar
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jon Hainer
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Josh Klein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Christopher P Cannon
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Donna M Polk
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Jorge Plutzky
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Khurram Nasir
- Department of Medicine, Yale University School of Medicine, New Haven, CT
| | - James L Januzzi
- Division of Cardiology, Massachusetts General Hospital, Harvard Medical School, and the Baim Institute for Clinical Research, Boston, MA
| | - Marcelo F Di Carli
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Deepak L Bhatt
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Ron Blankstein
- Cardiovascular Imaging Program, Departments of Medicine and Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
- Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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13
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Desai R, Patel U, Parekh T, Hanna B, Sitammagari K, Fong HK, Lodhi MU, Varma Y, Damarlapally N, Doshi R, Savani S, Kumar G, Sachdeva R. Nationwide Trends in Prevalent Cardiovascular Risk Factors and Diseases in Young Adults: Differences by Sex and Race and In-Hospital Outcomes. South Med J 2020; 113:311-319. [PMID: 32483642 DOI: 10.14423/smj.0000000000001106] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES Prevalence and trends in all cardiovascular disease (CVD) risk factors among young adults (18-39 years) have not been evaluated on a large scale stratified by sex and race. The aim of this study was to establish the prevalence and temporal trend of CVD risk factors in US inpatients younger than 40 years of age from 2007 through 2014 with racial and sex-based distinctions. In addition, the impact of these risk factors on inpatient outcomes and healthcare resource utilization was explored. METHODS A cross-sectional nationwide analysis of all hospitalizations, comorbidities, and complications among young adults from 2007 to 2014 was performed. The primary outcomes were frequency, trends, and race- and sex-based differences in coexisting CVD risk factors. Coprimary outcomes were trends in all-cause mortality, acute myocardial infarction, arrhythmia, stroke, and venous thromboembolism in young adults with CVD risk factors. Secondary outcomes were demographics and resource utilization in young adults with versus without CVD risk factors. RESULTS Of 63 million hospitalizations (mean 30.5 [standard deviation 5.9] years), 27% had at least one coexisting CVD risk factor. From 2007 to 2014, admission frequency with CVD risk factors increased from 42.8% to 55.1% in males and from 16.2% to 24.6% in females. Admissions with CVD risk were higher in male (41.4% vs 15.9%) and white (58.4% vs 53.8%) or African American (22.6% vs 15.9%) patients compared with those without CVD risk. Young adults in the Midwest (23.9% vs 21.1%) and South (40.8% vs 37.9%) documented comparatively higher hospitalizations rates with CVD risk. Young adults with CVD risk had higher all-cause in-hospital mortality (0.4% vs. 0.3%) with a higher average length of stay (4.3 vs 3.2 days) and charges per admission ($30,074 vs $20,124). CONCLUSIONS Despite modern advances in screening, management, and interventional measures for CVD, rising trends in CVD risk factors across all sex and race/ethnic groups call for attention by preventive cardiologists.
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Affiliation(s)
- Rupak Desai
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Upenkumar Patel
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Tarang Parekh
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Bishoy Hanna
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Kranthi Sitammagari
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Hee Kong Fong
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Muhammad Uzair Lodhi
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Yash Varma
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Nanush Damarlapally
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Rajkumar Doshi
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Sejal Savani
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Gautam Kumar
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
| | - Rajesh Sachdeva
- From the Division of Cardiology, Atlanta Veterans Affairs Medical Center, Decatur, Georgia, the Department of Internal Medicine, Nassau University Medical Center, East Meadow, New York, the Department of Health Administration and Policy, George Mason University, Fairfax, Virginia, the Division of Cardiology, Morehouse School of Medicine, Atlanta, Georgia, the Department of Internal Medicine, Atrium Health Union, Monroe, North Carolina, the Division of Cardiology, University of California, Davis Medical Center, Sacramento, the Department of Internal Medicine, Eastern Idaho Regional Medical Center, Idaho Falls, the Department of Medicine, Bhavnagar Medical College, Gujarat, India, the Department of Health Sciences, Coleman College of Health Sciences, Houston, Texas, the Department of Internal Medicine, University of Nevada, Reno School of Medicine, Reno, and the Department of Public Health, New York University, New York, New York
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14
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Perez O, Nair RM, Kewan T, Al-Jaghbeer MJ. A Rare Case of ST-elevation Myocardial Infarction After Blunt Chest Trauma. Cureus 2020; 12:e7710. [PMID: 32431988 PMCID: PMC7233491 DOI: 10.7759/cureus.7710] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Myocardial infarction (MI) after blunt chest trauma (BCT) is a rare but potentially life-threatening situation that should be addressed immediately in a patient who presents to the ED. Early management is directly related to favorable outcomes. Here we describe a case of ST-elevation MI after BCT.
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Affiliation(s)
- Oscar Perez
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Raunak M Nair
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
| | - Tariq Kewan
- Internal Medicine, Cleveland Clinic - Fairview Hospital, Cleveland, USA
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15
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Jortveit J, Pripp AH, Langørgen J, Halvorsen S. Incidence, risk factors and outcome of young patients with myocardial infarction. Heart 2020; 106:1420-1426. [DOI: 10.1136/heartjnl-2019-316067] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Revised: 12/30/2019] [Accepted: 01/08/2020] [Indexed: 11/04/2022] Open
Abstract
ObjectiveThe decline in the incidence and mortality of acute myocardial infarction (AMI) has been less among younger compared with older individuals. The aim of this nationwide study was to assess the current incidence, risk factors and outcome of AMI in patients <45 years of age.MethodsAll patients ≤80 years of age registered in the Norwegian Myocardial Infarction Register in 2013–2016 were included in this observational, nationwide cohort study. Follow-up was conducted through linkage with the Norwegian Patient Registry through 2017.ResultsAmong a total of 33 439 patients ≤80 years with AMI, 1468 (4.4%) were <45 years old. The incidence of AMI was 2.1 per 100 000 person-years in people aged 20–29 years, 16.9 in people aged 30–39 years and 97.6 in people aged 40–49 years. Compared with older patients, patients <45 years were more likely to be male (81%), current smokers (56%), obese (30%) and have a family history of premature AMI (44%), and their low-density lipoprotein-cholesterol levels were higher. Patients <45 years were more likely to have non-obstructive coronary artery disease (14% vs 10%, p<0.001) compared with older patients. During a median follow-up time of 2.4 years, 135 (9%) patients <45 years experienced a new AMI, stroke or death, and 58 (4%) patients died.ConclusionsThe rate of AMI was low in people <45 years old in Norway, but almost one in ten patients with AMI <45 years old died or experienced a new cardiovascular event during follow-up. Increased efforts to improve risk factor control in these patients are warranted.
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16
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Gulati R, Behfar A, Narula J, Kanwar A, Lerman A, Cooper L, Singh M. Acute Myocardial Infarction in Young Individuals. Mayo Clin Proc 2020; 95:136-156. [PMID: 31902409 DOI: 10.1016/j.mayocp.2019.05.001] [Citation(s) in RCA: 135] [Impact Index Per Article: 33.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/07/2019] [Accepted: 05/03/2019] [Indexed: 12/17/2022]
Abstract
Globally, cardiovascular disease remains a major cause of adverse outcomes in young individuals, unlike its decline in other age groups. This group is not well studied and has a unique risk profile with less traditional cardiovascular risk factors compared with older populations. Plaque rupture still remains the most common etiology of myocardial infarction, but unique syndromes such as plaque erosion, coronary microvascular dysfunction, spontaneous coronary artery dissection, and coronary spasm related to drug use are more prevalent in this age group. Such diversity of diagnosis and presentation, along with therapeutic implications, underscore the need to study the profile of myocardial infarction in young persons. We searched PubMed for articles published from 1980 to 218 using the terms acute myocardial infarction, young, plaque rupture, plaque erosion, spontaneous coronary artery dissection (SCAD), coronary vasospasm, variant or Prinzmetal angina, drug-induced myocardial infarction, myocarditis, coronary embolism, microvascular dysfunction, MINOCA, and myocardial infarction in pregnancy and reviewed all the published studies. With the data from this search, we aim to inform readers of the prevalence, risk factors, presentation, and management of acute myocardial infarction in young patients and elaborate on special subgroups with diagnostic and therapeutic challenges. We also outline a parsimonious method designed to simplify management of these complex patients.
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Affiliation(s)
- Rajiv Gulati
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Atta Behfar
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Jagat Narula
- Department of Medicine/Cardiology, Mount Sinai Hospital, New York, NY
| | | | - Amir Lerman
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN
| | - Leslie Cooper
- Department of Cardiovascular Medicine, Mayo Clinic, Jacksonville, FL
| | - Mandeep Singh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
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17
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Andreenko EY, Lukyanov MM, Yakushin SS, Vorobyev AN, Kudryashov EV, Yavelov IS, Klyashtorny VG, Pereverzeva KG, Boytsov SA, Drapkina OM. Young ambulatory patients with cardiovascular diseases: age and gender characteristics, comorbidity, medication and outcomes (according to RECVASA register). ACTA ACUST UNITED AC 2019. [DOI: 10.15829/1728-8800-2019-6-99-106] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
| | - M. M. Lukyanov
- National Medical Research Center for Preventive Medicine
| | | | | | | | - I. S. Yavelov
- National Medical Research Center for Preventive Medicine
| | | | | | | | - O. M. Drapkina
- National Medical Research Center for Preventive Medicine
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18
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Fach A, Osteresch R, Erdmann J, Munz M, Alberto Mata Marin L, Michel S, Retzlaff T, Wettwer T, Schmucker J, Hambrecht R, Wienbergen H. Long-term prevention after myocardial infarction in young patients ≤45 years: the Intensive Prevention Program in the Young (IPP-Y) study. Eur J Prev Cardiol 2019; 27:2264-2266. [PMID: 31674209 DOI: 10.1177/2047487319883960] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Andreas Fach
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Rico Osteresch
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Jeanette Erdmann
- Institute for Cardiogenetics, University of Lübeck, Germany.,DZHK (German Research Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Germany.,University Heart Center Lübeck, Germany
| | - Matthias Munz
- Institute for Cardiogenetics, University of Lübeck, Germany.,DZHK (German Research Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Germany.,University Heart Center Lübeck, Germany.,Department of Periodontology and Synoptic Dentistry, Charité - University Medicine Berlin, Germany
| | | | - Stephan Michel
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Tina Retzlaff
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Tineke Wettwer
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Johannes Schmucker
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Rainer Hambrecht
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany
| | - Harm Wienbergen
- Bremer Institute for Heart and Circulation Research, Klinikum Links der Weser, Germany.,DZHK (German Research Centre for Cardiovascular Research), partner site Hamburg/Lübeck/Kiel, Germany.,University Heart Center Lübeck, Germany
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19
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Beheshti S, Madsen CM, Varbo A, Nordestgaard BG. How To Identify Familial Premature Myocardial Infarction: Comparing Approaches To Identify Familial Hypercholesterolemia. J Clin Endocrinol Metab 2019; 104:2657-2667. [PMID: 30753598 DOI: 10.1210/jc.2018-02261] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2018] [Accepted: 02/04/2019] [Indexed: 02/13/2023]
Abstract
CONTEXT How best to identify families with premature myocardial infarction is unclear. OBJECTIVE We compared approaches to identify familial premature myocardial infarction in the general population using different familial hypercholesterolemia (FH) criteria and low-density lipoprotein (LDL) cholesterol cut-points. DESIGN AND SETTING Clinical and mutation criteria for FH and LDL cholesterol cut-points were applied for identification of familial premature myocardial infarction in 106,732 individuals from the Copenhagen General Population Study. RESULTS FH criteria identified 898 (13%) cases with familial premature myocardial infarction, leaving 5856 (87%) cases undetected. The ORs for familial premature myocardial infarction, compared with the respective remainder groups, were 4.7 (95% CI, 3.7 to 6.0) for clinical FH by Dutch Lipid Clinic Network criteria, 4.4 (4.0 to 4.7) for Simon Broome criteria, 2.1 (95% CI, 1.7 to 3.6) for Make Early Diagnosis to Prevent Early Death criteria, 2.1 (95% CI, 1.4 to 3.3) for FH mutation, and 1.4 (95% CI, 1.3 to1.6) for LDL cholesterol ≥5 mmol/L (193 mg/dL). For these risk groups, the sensitivity (true positive rate) for identification of familial premature myocardial infarction were 1.3%, 13%, 1.6%, 0.9%, and 7.1%, respectively. Compared with universal screening of a similar fraction of the population, the relative increase in sensitivity for these risk groups was 3.8-fold [fraction of population examined: 0.3%, 3.3-fold (4%), 2.0-fold (0.8%), 2.0-fold (0.4%), and 1.4-fold (5.3%), respectively]. CONCLUSION Criteria for FH identify a small fraction of individuals with familial premature myocardial infarction in the general population. Actively identifying families with premature myocardial infarction would be of potential preventive importance, and this study provides data that could be used to choose the best method for such family identification.
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Affiliation(s)
- Sabina Beheshti
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej, Herlev, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Christian M Madsen
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej, Herlev, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Anette Varbo
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej, Herlev, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Børge G Nordestgaard
- Department of Clinical Biochemistry, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej, Herlev, Denmark
- The Copenhagen General Population Study, Herlev and Gentofte Hospital, Copenhagen University Hospital, Herlev Ringvej, Herlev, Denmark
- Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Ruiz Pizarro V, Palacios-Rubio J, Cruz-Utrilla A, García-Arribas D, Pérez-Vizcayno MJ, Fernández-Ortiz A, Núñez-Gil IJ. ST-Elevation Myocardial Infarction in Patients ≤35 Years of Age. Am J Cardiol 2019; 123:889-893. [PMID: 30600083 DOI: 10.1016/j.amjcard.2018.12.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/25/2018] [Revised: 12/03/2018] [Accepted: 12/13/2018] [Indexed: 12/22/2022]
Abstract
ST-elevation myocardial infarction (STEMI) in very young patients is an uncommon entity but with significant clinical meaning for the patient. These individuals may have different risk profiles and prognosis. Few reports have described epidemiology, clinical features, and long-term outcomes of these patients in the era of percutaneous coronary intervention, particularly of those ≤35. This observational study evaluates the clinical characteristics of patients <35 years with STEMI between January 2004 and September 2016 in 3 different centers. We gathered data and follow-up from the prospective database of the interventional cardiology department, medical history, and phone interviews. Over a total of 3,883 STEMI, we retrieved 61 patients ≤35. They were mainly male (88%), smokers (80%), and overweight (67%). Twenty-six percent were drug consumers. Only 2 patients (3%) were free of conventional risk factors. In-hospital mortality was 5% (3 deaths). They were followed-up for 5.9 ± 4.2 years with a total survival of 96.6% (2 deaths). Major adverse cardiovascular events incidence at the end of follow-up was only 17.2% (10 patients). STEMI in the young is a rare condition. These patients have several modifiable predisposing factors, a low clinical risk profile, and excellent short- and long-term prognosis with state-of-the-art treatment.
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21
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Andreenko EY, Yavelov IS, Loukianov ММ, Vernohaeva AN, Drapkina OM, Boytsov SA. Ischemic Heart Disease in Subjects of Young Age: Current State of the Problem. Features of Etiology, Clinical Manifestation and Prognosis. ACTA ACUST UNITED AC 2018; 58:24-34. [PMID: 30625075 DOI: 10.18087/cardio.2018.11.10195] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 11/24/2018] [Indexed: 11/18/2022]
Abstract
In addition to conventional risk factors in young patients with ischemic heart disease (IHD) numerous other risk factors including genetics play an important role in its causation. Molecular genetic testing is recommended for the detection of monogenic diseases with a high risk of developing IHD, such as familial hypercholesterolemia. In majority ofyoung patients, the first manifestation of IHD is an acute coronary syndrome. Young patients with IHD more often have normal coronary arteries or single-vessel coronary disease, and in up to 20% of them cause of myocardial ischemia is not related to atherosclerosis. In general, young patients with IHD have better prognosis. However, there are sex differences in IHD outcomes the prognosis of patients with premature IHD and reason for this is still unclear.
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Affiliation(s)
- E Yu Andreenko
- National Medical Research Center for Preventive Medicine.
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22
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Kim I, Kim MC, Sim DS, Hong YJ, Kim JH, Jeong MH, Cho JG, Park JC, Seung KB, Chang K, Ahn Y. Effect of the Metabolic Syndrome on Outcomes in Patients Aged <50 Years Versus >50 Years With Acute Myocardial Infarction. Am J Cardiol 2018; 122:192-198. [PMID: 29729896 DOI: 10.1016/j.amjcard.2018.03.366] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2017] [Revised: 03/24/2018] [Accepted: 03/29/2018] [Indexed: 01/11/2023]
Abstract
The presence of metabolic syndrome (MS) is associated with an increased risk of cardiovascular disease morbidity and mortality. Moreover, data are lacking on the association of MS with clinical outcomes in young adults with acute myocardial infarction (AMI). This study was a retrospective analysis of 2,082 patients with AMI who underwent percutaneous coronary intervention. The term young was defined as age <50 years. The prevalence of patients aged <50 years was 18.4%. Among those patients, 43.4% had MS. The highest incidence of long-term major adverse cardiac and cerebral events was in old patients without MS (30.7% in young patients with MS, 22.2% in young patients without MS, 38.4% in old patients with MS, and 40.4% in old patients without MS, p <0.001). However, recurrent AMI (re-AMI) was the highest in young AMI patients with MS (4.8%, 1.4%, 2.1%, and 1.5%, p = 0.035, respectively). In Kaplan-Meier curve, young AMI patients with MS tend to have highest incidence of re-AMI (p = 0.050). The presence of MS in young AMI patients was an independent predictor of 6-year major adverse cardiac and cerebral events (hazard ratio 3.320, 95% confidence interval 1.073 to 10.283, p = 0.038) and re-AMI (hazard ratio 7.782, 95% confidence interval 1.290 to 45.298, p = 0.022). In conclusion, almost half of young patients with AMI had MS. The young AMI patients with MS had the highest incidence of re-AMI compared with the other groups. Aggressive pharmacological intervention and lifestyle modification are needed for the management of AMI in young patients with MS.
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Gao M, Zhao W, Zhang Z, Qin L, Zhang W, Zheng Y. Clinical Characteristics and Outcomes in Young Patients With ST-Segment Elevation Myocardial Infarction After Primary Percutaneous Coronary Intervention. Am J Med Sci 2018; 355:544-552. [PMID: 29891037 DOI: 10.1016/j.amjms.2018.02.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2017] [Revised: 02/05/2018] [Accepted: 02/06/2018] [Indexed: 01/30/2023]
Abstract
BACKGROUND There are few published studies of ST-segment elevation myocardial infarction (STEMI) in younger individuals. The differences between these "younger" and "older" individuals may not be fully appreciated by clinicians. The aim of this study was to determine the reasons for the earlier presentation and help to identify strategies for prevention of recurrent myocardial infarction (MI) in younger patients. METHODS The study population was a cohort of 2,419 consecutive STEMI patients who were treated with primary percutaneous coronary intervention. The median follow-up time of this retrospective study was 2.2 years. RESULTS The all-cause mortality rates in patients ≤45 years of age at 30 days, 1 and 2 years were 1.7%, 2.0% and 2.2%, respectively. These rates were lower compared with their older matched counterparts whose all-cause mortality rates were 3.3%, 4.2% and 5.5%, respectively (P = 0.010). The incidence of recurrent MI was 4.0% for all age groups combined, 5.4% for younger patients and 3.8% for older patients. The number of stents showed association with recurrent MI in older patients with a first infarction, whereas only composition factor 1 with significantly higher non-high-density lipoprotein and low-density lipoprotein values was significantly associated with recurrent MI in the younger patients. CONCLUSIONS STEMI patients ≤45 years of age more often had lower rates of all-cause mortality, but the risk of recurrent MI was similar to that of older patients. Regardless of triglyceride level, neither non-high-density lipoprotein nor low-density lipoprotein were independent predictors for recurrent MI during the long-term follow-up in younger patients.
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Affiliation(s)
- Ming Gao
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Waiou Zhao
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Zhiguo Zhang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Ling Qin
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Weihua Zhang
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China
| | - Yang Zheng
- Department of Cardiology, The First Hospital of Jilin University, Changchun, China.
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24
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Do You Know How Young Your Heart Is? ARS MEDICA TOMITANA 2018. [DOI: 10.2478/arsm-2018-0012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
We present the case of a 25 years old patient who was submitted to our unit with a first time acute coronary syndrome. Despite his young age he had multiple cardiovascular risk factors. Although the chest pain was atypical and the electrocardiogram on presentation had unspecific changes, repeated investigations established the diagnosis of anterolateral myocardial infarction. Per primam angioplasty with stent implantation in the proximal segment of left anterior descending artery was performed, with good clinical outcome. Awareness is the key in establishing the diagnosis of myocardial infarction in young patients.
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Abstract
We herein report the case of a 25-year-old Japanese woman with left-main-trunk acute myocardial infarction (LMT-AMI). She had cardiogenic shock, so emergency percutaneous intervention was performed. Intravascular ultrasound of LMT-AMI showed that the three-layered structure of the intima, tunica media, and adventitia was not clearly visible, and the vessel was concentrically thickened; unstable plaque and calcification were not seen. AMI is rarely seen in young women, but Takayasu's arteritis is one major cause. If a young woman complaining of typical chest pain as acute coronary syndrome is encountered, systemic diseases must be considered.
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Affiliation(s)
- Yusuke Ishiyama
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Kazuo Eguchi
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Katsuaki Yokota
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Tomokazu Ikemoto
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Japan
| | - Kazuomi Kario
- Division of Cardiovascular Medicine, Department of Medicine, Jichi Medical University, Japan
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Pillay AK, Naidoo DP. Atherosclerotic disease is the predominant aetiology of acute coronary syndrome in young adults. Cardiovasc J Afr 2017; 29:36-42. [PMID: 29293260 PMCID: PMC6002794 DOI: 10.5830/cvja-2017-035] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 07/13/2017] [Indexed: 01/09/2023] Open
Abstract
Objectives Few studies have evaluated young adults in their third and fourth decades with coronary artery disease (CAD). This study evaluated the clinical and angiographic profile of young adults (< 35 years) with CAD. Methods A 10-year (2003–2012) retrospective chart reviewwas performed on patients less than 35 years diagnosed withCAD at Inkosi Albert Luthuli Central Hospital, Durban. Results Of the 100 patients who met the study criteria, the majority were male (90%), of Indian ethnicity (79%), and presented with acute coronary syndrome (93%). Smoking (82%), dyslipidaemia (79%) and dysglycaemia (75%) were the most prevalent risk factors. Almost half of the subjects (48%) met criteria for the metabolic syndrome. Angiographic findings revealed multi-vessel (42%), single-vessel (36%) and non-occlusive disease (20%); only two subjects had normal epicardial vessels. Disease severity was influenced by dyslipidaemia (p = 0.002) and positive family history (p = 0.002). Non-coronary aetiologies were identified in 19% of subjects. Conclusions Atherosclerotic disease associated with risk-factor clustering was highly prevalent in young adults with CAD.
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Affiliation(s)
- A K Pillay
- Department of Internal Medicine, University of KwaZulu-Natal, Durban, South Africa.
| | - D P Naidoo
- Department of Cardiology, University of KwaZulu-Natal, Durban, South Africa
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27
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Matsis K, Holley A, Al-Sinan A, Matsis P, Larsen PD, Harding SA. Differing Clinical Characteristics Between Young and Older Patients Presenting with Myocardial Infarction. Heart Lung Circ 2017; 26:566-571. [DOI: 10.1016/j.hlc.2016.09.007] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Revised: 08/03/2016] [Accepted: 09/02/2016] [Indexed: 11/26/2022]
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28
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Aggarwal A, Srivastava S, Velmurugan M. Newer perspectives of coronary artery disease in young. World J Cardiol 2016; 8:728-734. [PMID: 28070240 PMCID: PMC5183972 DOI: 10.4330/wjc.v8.i12.728] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/03/2016] [Accepted: 11/02/2016] [Indexed: 02/06/2023] Open
Abstract
Coronary artery disease (CAD) occurring in less than 45 years of age is termed as young CAD. Recent studies show a prevalence of 1.2% of CAD cases in this age group. Ethnic wise south Asians especially Indians are more vulnerable to have CAD in young age group with a prevalence of 5% to 10%. Conventional risk factors such as smoking, diabetes, hypertension, obesity and family history seems to be as important as in older CAD subjects. But the prevalence of these risk factors seems to vary in younger subjects. By far the most commonly associated risk factor is smoking in young CAD. Several genes associated with lipoprotein metabolism are now found to be associated with young CAD like cholesterol ester transfer protein (CETP) gene, hepatic lipase gene, lipoprotein lipase gene, apo A1 gene, apo E gene and apo B. Biomarkers such as lipoprotein (a), fibrinogen, D-dimer, serum Wnt, gamma glutamyl transferase, vitamin D2 and osteocalcin are seems to be associated with premature CAD in some newer studies. In general CAD in young has better prognosis than older subjects. In terms of prognosis two risk factors obesity and current smoking are associated with poorer outcomes. Angiographic studies shows predominance of single vessel disease in young CAD patients. Like CAD in older person primary and secondary prevention plays an important role in prevention of new and further coronary events.
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29
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Alkhawam H, Sogomonian R, El-Hunjul M, Kabach M, Syed U, Vyas N, Ahmad S, Vittorio TJ. Risk factors for coronary artery disease and acute coronary syndrome in patients ≤40 years old. Future Cardiol 2016; 12:545-52. [PMID: 27492147 DOI: 10.2217/fca-2016-0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE In this study, we assessed the risk factor profile in premature coronary artery disease (CAD) and acute coronary syndrome for adults ≤40 years old. METHODS A retrospective chart analysis of 397 patients ≤40 years old admitted from 2005 to 2014 for chest pain and who underwent coronary arteriography. RESULTS Of 397 patients that had undergone coronary arteriography, 54% had CAD while 46% had normal coronary arteries. When compared with patients with normal coronary arteries, patients with CAD were more likely to smoke tobacco, have dyslipidemia, be diabetic, have BMI >30 kg/m(2), have a family history of premature CAD and be male in gender. CONCLUSION Healthcare intervention in the general population through screening, counseling and education regarding the risk factors is warranted to reduce premature CAD.
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Affiliation(s)
- Hassan Alkhawam
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Robert Sogomonian
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Mohammed El-Hunjul
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Mohamad Kabach
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Umer Syed
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Neil Vyas
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Sumair Ahmad
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Timothy J Vittorio
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
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Comparison of Long-Term Mortality of Patients Aged ≤40 Versus >40 Years With Acute Myocardial Infarction. Am J Cardiol 2016; 118:319-25. [PMID: 27328956 DOI: 10.1016/j.amjcard.2016.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
Young patients with acute myocardial infarction (MI) have a more favorable prognosis than older patients with MI. However, there are limited data comparing the prognosis of young patients with MI with young population controls. Comparison with an age-matched background population could unmask residual mortality risk in young patients with MI that would otherwise not be apparent when merely comparing the mortality risk of young and older patients with MI. We studied 15,151 patients with AMI from 2000 to 2005, of which 601 patients were ≤40 years (young MI). The relative survival ratio (RSR) was calculated as the ratio of the observed survival of patients with MI divided by the expected survival, estimated from the background population (n = 3,771,700) matched for age, gender, and follow-up year. An RSR of <1.0 or >1.0 indicates poorer or better survival, respectively, than the background population. The 12-year all-cause and cardiovascular mortality of young versus older patients was 12.8% versus 50.7% (p <0.001) and 9.2% versus 34.5% (p <0.001), respectively. The adjusted hazard ratio (95% confidence interval) for all-cause and cardiovascular mortality comparing young with older patients was 0.20 (0.16 to 0.27) and 0.27 (0.20 to 0.36), respectively. The RSR (95% confidence interval) of young and older patients was, respectively, 0.969 (0.950 to 0.980) and 0.804 (0.797 to 0.811) at 1 year, 0.942 (0.918 to 0.960) and 0.716 (0.707 to 0.726) at 5 years, and 0.908 (0.878 to 0.938) and 0.638 (0.620 to 0.654) at 9 years. In conclusion, despite a fivefold lower long-term mortality than older patients with MI, young patients with MI remain at significantly greater risk of long-term mortality than an age-matched background population.
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Microvolt T-wave alternans in young myocardial infarction patients with preserved cardiac function treated with single-vessel primary percutaneous coronary intervention. ACTA ACUST UNITED AC 2016; 1:e68-e74. [PMID: 28905024 PMCID: PMC5421539 DOI: 10.5114/amsad.2016.61494] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2016] [Accepted: 07/13/2016] [Indexed: 11/17/2022]
Abstract
Introduction Myocardial infarction continues to be the most important cause of morbidity and mortality, and recently this disease has begun to be seen commonly at young ages. In our study we aimed to assess microvolt T-wave alternans in young patients who had ST segment elevation myocardial infarction with preserved left ventricular function and who underwent single-vessel revascularization. Material and methods We enrolled 108 consecutive patients (age: 39.5 ±4.1) with ST segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention and 43 patients (age: 38.5 ±3.7) with normal coronary angiograms as a control group. The myocardial infarction patients were younger than 45 and had a preserved left ventricular ejection fraction. They were divided into three groups according to the culprit artery. The microvolt T-wave alternans (MTWA) values were calculated an average of 12 months after the primary percutaneous coronary intervention using the modified moving average method. Results The MTWA positivity was significantly higher in the STEMI group compared to the controls (p < 0.001). It was also significantly higher in STEMI patients with left anterior descending artery lesions compared to patients with circumflex artery and right coronary artery lesions (p = 0.013). Moreover, the culprit artery was independent predictor of MTWA positivity (p = 0.043). Conclusions In STEMI patients of a young age, MTWA positivity was higher than in healthy individuals, especially when the responsible vessel fed a wider region.
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Shah N, Kelly AM, Cox N, Wong C, Soon K. Myocardial Infarction in the "Young": Risk Factors, Presentation, Management and Prognosis. Heart Lung Circ 2016; 25:955-60. [PMID: 27265644 DOI: 10.1016/j.hlc.2016.04.015] [Citation(s) in RCA: 78] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Revised: 12/31/2015] [Accepted: 04/10/2016] [Indexed: 12/15/2022]
Abstract
Myocardial infarction (MI) in the "young" is a significant problem, however there is scarcity of data on premature coronary heart disease (CHD) and MI in the "young". This may lead to under-appreciation of important differences that exist between "young" MI patients versus an older cohort. Traditional differences described in the risk factor profile of younger MI compared to older patients include a higher prevalence of smoking, family history of premature CHD and male gender. Recently, other potentially important differences have been described. Most "young" MI patients will present with non-ST elevation MI but the proportion presenting with ST-elevation MI is increasing. Coronary angiography usually reveals less extensive disease in "young" MI patients, which has implications for management. Short-term prognosis of "young" MI patients is better than for older patients, however contemporary data raises concerns regarding longer-term outcomes, particularly in those with reduced left ventricular systolic function. Here we review the differences in rate, risk factor profile, presentation, management and prognosis between "young" and older MI patients.
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Affiliation(s)
- Nadim Shah
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia.
| | - Anne-Maree Kelly
- Joseph Epstein Centre for Emergency Medicine Research, Western Health, Melbourne, Vic, Australia
| | - Nicholas Cox
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia
| | - Chiew Wong
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia
| | - Kean Soon
- Centre for Cardiovascular Therapeutics, Western Health, Melbourne, Vic, Australia
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Elkhader BA, Abdulla AA, Ali Omer MA. Correlation of Smoking and Myocardial Infarction Among Sudanese Male Patients Above 40 Years of Age. Pol J Radiol 2016; 81:138-40. [PMID: 27081418 PMCID: PMC4818030 DOI: 10.12659/pjr.894068] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2015] [Accepted: 03/24/2015] [Indexed: 02/02/2023] Open
Abstract
To find an association between smoking and the development of myocardial infarction in male patients above forty years of age presenting at the echocardiology department of Sudan heart center Khartoum. A prospective cohort study was carried out at the echocardiography department of Sudan Heart Center in Khartoum-Sudan between July 2012 and June 2014. The study population comprised a total of 168 adult male patients who underwent cardiac ultrasound scanning. Out of a total of 144 cases, 65% (94) of patients were smokers, 74% of the 94 cases smoked for more than 10 years, and 26% of the 94 cases smoked for less than 10 years. With this study it was concluded that smoking is a risk factor for the development of myocardial infarction. This study showed that patients with myocardial infarction are more likely to have a past history of smoking.
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Affiliation(s)
- Bahaaedin A Elkhader
- College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan
| | - Alsafi A Abdulla
- College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan
| | - Mohammed A Ali Omer
- College of Medical Radiological Sciences, Sudan University of Science and Technology, Khartoum, Sudan; Department of Radiologic Technology, College of Applied Medical Sciences, Qassim University, Buraidah, Sudan
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Abstract
Coronary heart disease (CHD) sustains a significant negative impact on hospital admissions and deaths worldwide. The prevalence of CHD in young adults is difficult to establish accurately, as these asymptomatic patients typically do not undergo diagnostic studies. In this article, the authors will focus on young adults with CHD emphasizing common and uncommon risk factors, current management and review of previous studies.
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Feijó IP, Schmidt MM, David RB, Martins JMP, Schmidt KE, Gottschall CAM, Quadros ASD. Clinical profile and outcomes of primary percutaneous coronary intervention in young patients. ACTA ACUST UNITED AC 2015. [DOI: 10.1016/j.rbciev.2015.01.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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36
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Shah N, Soon K, Wong C, Kelly AM. Screening for asymptomatic coronary heart disease in the young 'at risk' population: Who and how? IJC HEART & VASCULATURE 2014; 6:60-65. [PMID: 28785628 PMCID: PMC5497146 DOI: 10.1016/j.ijcha.2014.12.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 12/20/2014] [Indexed: 01/13/2023]
Abstract
Deaths due to coronary heart disease (CHD) remain high worldwide, despite recent achievements. An effective screening strategy may improve outcomes further if implemented in a high or ‘at risk’ cohort. Asymptomatic CHD in the young maybe underappreciated and applying an effective screening strategy to a young cohort may lead to improved outcomes due to significant socioeconomic impact from the consequences of CHD in this sub-group. A positive family history of CHD, which is known to be associated with an increased risk of future myocardial events, could aid in identifying the ‘at risk’ young cohort. Traditional cardiovascular risk scoring systems are in wide use but lack the sensitivity or specificity required to estimate risk in an individual. Rather their use is limited to predicting population attributable risk. Functional studies such as exercise stress tests are readily available and cost effective but do not have the required sensitivity required to suggest their use as part of a screening protocol. Coronary CT angiography has been demonstrated to have high sensitivity for the detection of CHD and therefore may be suitable for screening purposes but there are concerns regarding radiation exposure. Here we review the evidence for the use of potential screening strategies and the suitability of using such strategies to estimate risk of CHD in a young ‘at risk’ population.
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Yunyun W, Tong L, Yingwu L, Bojiang L, Yu W, Xiaomin H, Xin L, Wenjin P, Li J. Analysis of risk factors of ST-segment elevation myocardial infarction in young patients. BMC Cardiovasc Disord 2014; 14:179. [PMID: 25487289 PMCID: PMC4271480 DOI: 10.1186/1471-2261-14-179] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 12/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) is often present in old populations and rare in young people. Its incidence significantly increased recent years. The mechanism and disease course of AMI in young people are probably different from that in old population. The aim of this study was to analyze clinical risk factors of STEMI in young patients. METHODS Data was collected from consecutive patients ≤ 44 years of age (young; n = 86) and 60-74 years of age (old; n = 65) diagnosed with STEMI, and 79 young age-matched patients without coronary artery disease (CAD), hospitalized between January 2009 and June 2013. RESULTS The young STEMI group had a significantly higher proportion of males (88.37 vs. 53.16%; P < 0.01), smokers (82.56 vs. 49.37%; P < 0.01) and patients with a family history of early CAD (54.65 vs. 32.91%; P < 0.05) than age-matched controls. Young STEMI patients also had significantly higher levels of fasting blood sugar (6.39 vs. 5.25 mmol/L; P < 0.001), glycated hemoglobin (HbA1c) (6.26 vs. 5.45%; P < 0.05), total cholesterol (5.14 vs. 4.65 mmol/L, P < 0.05), and fibrinogen (Fib) (3.39 vs. 2.87; P < 0.01). Compared with the old STEMI group, young STEMI patients had significantly higher proportions of males (88.37 vs. 63.08%; P < 0.01) smokers (82.56 vs. 41.54%; P < 0.01), and those with a family history of early CAD (54.65 vs. 18.46%; P < 0.01). Young STEMI patients also lower Fib (3.39 vs. 3.88 g/L; P < 0.01), less frequent occurrence of angina pectoris before STEMI (13.95 vs. 29.23%; P < 0.05) compared with the old STEMI group. Logistic regression analysis indicated that male sex (OR = 5.891), smoking (OR = 3.500), family history of early CAD (OR = 3.194), Fib (OR = 2.414) and HbA1c (OR = 1.515) are associated with STEMI in young patients. CONCLUSION In addition to previously recognized risk factors (male sex, smoking and family history of early CAD), Fib and HbA1c are associated with STEMI in individuals ≤ 44 years of age without antecedent angina pectoris.
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Affiliation(s)
- Wang Yunyun
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Li Tong
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Liu Yingwu
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Liu Bojiang
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Wang Yu
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Hu Xiaomin
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Li Xin
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Peng Wenjin
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - JinFang Li
- />Essen Medical Associates, P.C.2015 Grand concourse, Bronx, NY 10453 USA
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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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Scott AC, Bilesky J, Lamanna A, Cullen L, FT Brown A, Denaro C, Parsonage W. Limited utility of exercise stress testing in the evaluation of suspected acute coronary syndrome in patients aged less than 40 years with intermediate risk features. Emerg Med Australas 2014; 26:170-6. [DOI: 10.1111/1742-6723.12222] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/15/2013] [Indexed: 01/23/2023]
Affiliation(s)
- Adam C Scott
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Public Health; Queensland University of Technology; Brisbane Queensland Australia
| | - Jennifer Bilesky
- Department of Emergency Medicine; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - Arvin Lamanna
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Louise Cullen
- School of Public Health; Queensland University of Technology; Brisbane Queensland Australia
- Department of Emergency Medicine; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Anthony FT Brown
- Department of Emergency Medicine; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
| | - Charles Denaro
- Department of Internal Medicine; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
| | - William Parsonage
- Department of Cardiology; Royal Brisbane and Women's Hospital; Brisbane Queensland Australia
- School of Medicine; University of Queensland; Brisbane Queensland Australia
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41
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Jinnouchi H, Sakakura K, Wada H, Kubo N, Sugawara Y, Funayama H, Ako J, Momomura SI. Clinical features of myocardial infarction in young Japanese patients. Int Heart J 2013; 54:123-8. [PMID: 23774233 DOI: 10.1536/ihj.54.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clinical features and outcomes of acute myocardial infarction (AMI) in the young have been poorly investigated. The aim of this study was to investigate the clinical features and hospital outcomes of AMI in young Japanese. We conducted a case-control study. A total of 53 consecutive AMI patients whose age was ≤ 45 years old were assigned to the young group and 106 AMI patients whose age was > 45 years old were assigned to the non-young group. We compared the clinical features and hospital outcomes between the two groups. Compared with the non-young group, the young group was associated with male sex, hyperlipidemia, current smoking, being overweight, single vessel disease, and Killip class I on admission. There were no differences in the length of hospital stay or major adverse cardiac events between the groups. However, mortality and ventricular rupture were slightly lower in the young. In conclusion, young AMI patients had clinical characteristics different to those of the non-young patients. Compared to non-young patients, modifiable risk factors such as smoking, hyperlipidemia, and being overweight were associated with young AMI patients.
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Affiliation(s)
- Hiroyuki Jinnouchi
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
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Albarak J, Nijjar AP, Aymong E, Wang H, Quan H, Khan NA. Outcomes in Young South Asian Canadians After Acute Myocardial Infarction. Can J Cardiol 2012; 28:178-83. [DOI: 10.1016/j.cjca.2011.10.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 09/15/2011] [Accepted: 10/09/2011] [Indexed: 10/14/2022] Open
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43
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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: 35] [Impact Index Per Article: 2.7] [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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Collin MJ, Weisenthal B, Walsh KM, McCusker CM, Shofer FS, Hollander JE. Young patients with chest pain: 1-year outcomes. Am J Emerg Med 2011; 29:265-70. [DOI: 10.1016/j.ajem.2009.09.031] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2009] [Revised: 09/23/2009] [Accepted: 09/24/2009] [Indexed: 11/30/2022] Open
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L J, N B, O R, J-Y W, R LB, J L, J-P M. [Acute myocardial infarction in young smokers treated by coronary angioplasty. In-hospital prognosis and long-term outcome in a consecutive series of 93 patients]. Ann Cardiol Angeiol (Paris) 2010; 59:119-24. [PMID: 20511119 DOI: 10.1016/j.ancard.2010.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 04/06/2010] [Indexed: 11/16/2022]
Abstract
AIMS OF THE STUDY The study evaluated in-hospital and long-term outcome of patients less than 50 years old with myocardial infarction within 12 hours after symptom onset treated by coronary angioplasty. PATIENTS AND METHOD This is a retrospective study with survival analysis by Kaplan-Meier method in patients included from December 2003 to February 2008. RESULTS We included 93 patients aged 42,8+/-5,2 years old with smoking estimated at 27,7+/-12,7 pack-years. Thirty-one patients (33,3%) were dyslipidemic and 36 patients had family history of coronary artery disease. Thirty patients (32,3%) had an anterior myocardial infarction and four patients (4.4%) had Killip greater than 2. Coronary angioplasty was performed within 4.5+/-3.0 hours after symptom onset with TIMI 3 final flow in the culprit vessel in 96.8%. One patient died from cardiogenic shock. With a follow-up of 85 patients during 20.0+/-15.6 months, the survival without death was 98.2% and survival without major cardiac complication was 87.9% at 24 months. Seventy-two patients (85.7%) were taking a betablocker, 81 patients (96.4%) aspirin, 75 patients (89.3%) a statin and 64 patients (76.2%) an angiotensin-converting inhibitor. Only 50 patients (58.8%) were nonsmokers. CONCLUSION Thus, young smokers with acute MI treated by coronary angioplasty have a good prognosis during in-hospital stay and long-term outcome. Secondary medical treatment prevention is well followed but there is a low rate of smoking cessation.
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Affiliation(s)
- Jacquemin L
- Service de cardiologie, centre hospitalier Emile-Muller, 20, rue du Docteur Laennec, Mulhouse, France.
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Landzberg J, Gardin JM. Risk Factors for Heart Failure in Young Adults. CURRENT CARDIOVASCULAR RISK REPORTS 2010. [DOI: 10.1007/s12170-010-0079-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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47
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Kang WY, Jeong MH, Ahn YK, Kim JH, Chae SC, Kim YJ, Hur SH, Seong IW, Hong TJ, Choi DH, Cho MC, Kim CJ, Seung KB, Chung WS, Jang YS, Rha SW, Bae JH, Cho JG, Park SJ. Are patients with angiographically near-normal coronary arteries who present as acute myocardial infarction actually safe? Int J Cardiol 2009; 146:207-12. [PMID: 19664828 DOI: 10.1016/j.ijcard.2009.07.001] [Citation(s) in RCA: 87] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2008] [Revised: 06/17/2009] [Accepted: 07/07/2009] [Indexed: 02/08/2023]
Abstract
BACKGROUND There is a paucity of data concerning the clinical outcome of patients presenting with acute myocardial infarction (AMI) and near-normal coronary angiograms. The purpose of this study was to evaluate the clinical outcome and the prognosis of the patients with near-normal coronary angiograms who were registered in the Korean Acute Myocardial Infarction Registry (KAMIR). METHODS The subjects were divided into three groups according to findings from coronary angiograms performed between September 2005 and November 2006. Among 8510 consecutive AMI patients, 372 patients (Group I) had near-normal coronary arteries, 6136 patients (Group II) had one- or two-vessel disease, and 2002 patients (Group III) had three-vessel or left main disease. RESULTS Clinical characteristics, in-hospital mortality, and major cardiac adverse events (MACE) were analyzed. Group I was younger, had the lower prevalence of DM, and showed the higher percentage of previous angina history compared to the other two groups. Group III showed a higher incidence of in-hospital mortality, but there was no significant difference between Group I and Group II (2.6% in Group II and 2.2% in Group I, p=0.952). Furthermore, MACE at 1 month, 6 months and 12 months revealed no significant difference between Groups I and II (12 month MACE: 7.8% in Group I and 12.2% in Group II, p=0.359). CONCLUSIONS Patients with near-normal coronary angiograms had similar clinical outcomes and prognosis compared with one- or two-vessel diseased patients presenting with an acute myocardial infarction.
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Affiliation(s)
- Won Yu Kang
- Chonnam National University, Gwangju, South Korea
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Heartscore calculated in individuals younger than 40 years is related to vascular markers of early atherosclerosis. ACTA ACUST UNITED AC 2009; 15:619-24. [PMID: 18753953 DOI: 10.1097/hjr.0b013e32830f95a4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heartscore is not well validated for individuals less than 40 years of age. In the latest guidelines a relative risk chart is provided with the proposal to be used for young adults aged less than 60 years instead of projecting risk at the age of 60 years. Moreover, coronary artery disease is insidiously manifested in younger patients. DESIGN Cross-sectional study. METHODS Two hundred and two young Greeks of age less than 40 years and 232 middle-aged adults aged 40-60 years without clinically overt cardiovascular disease or diabetes were consecutively recruited. Flow-mediated dilatation of the brachial artery, carotid, and femoral intima media thickness (IMT), carotid-radial and carotid-femoral pulse wave velocity (PWV) were measured in all individuals in one session. The European Society of Cardiology online Heartscore calculator was used for mortality risk (MR) 60 and Systematic Coronary Risk Evaluation risk charts for relative risk (RR) computation. RESULTS MR60 in the younger significantly correlated with all measured vascular markers whereas RR significantly correlated with carotid IMT. By multivariate regression analysis, MR60 was a stronger identifier than RR for PWV, mean carotid and femoral IMT in both groups. Young adults (<40 years) with a high MR60 (>5%) had significantly higher carotid-radial PWV, carotid and femoral IMT whereas those with a high RR (>3rd tertile) had significantly higher carotid IMT. CONCLUSION MR60 was a stronger identifier of most of the measured markers of early atherosclerosis as compared with RR. These data support Heartscore as a prognostic tool in terms of primary prevention for participants younger than 40 years old.
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Mazurkiewicz L, Bilinska ZT, Kruk M, Ciszewski A, Grzybowski J, Witkowski A, Ruzyllo W. Baseline clinical characteristics and midterm prognosis of STE-ACS and NSTE-ACS patients with normal coronary arteries. Ann Noninvasive Electrocardiol 2009; 14:4-12. [PMID: 19149787 DOI: 10.1111/j.1542-474x.2008.00267.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE We sought to compare clinical profiles and midterm prognosis of patients with normal coronary arteries presenting with ST-elevation ACS (STE-ACS) versus non-ST-elevation ACS (nSTE-ACS). BACKGROUND There are limited data regarding ACS in patients with normal coronary arteries, and especially clinical differences between ST-ACS and nSTE-ACS patients have not been evaluated sufficiently. METHODS The study group comprised 190 patients (mean age: 53.2 years, 63.1% males, 63.6% STE-ACS) presenting with ACS and normal coronary angiograms. The participants were evaluated in terms of 42 clinical variables. MACE [cardiac death (CD) and hospitalization for angina (HA)] were the study end points. RESULTS STE-ACS in comparison to nSTE-ACS patients were younger (P < 0.01), were more frequently males (P < 0.01), had more often infection prior to ACS (P < 0.01), higher hsCRP on admission (P < 0.01), and greater infarct size, measured by maximal troponin I (P < 0.01). By multivariate analysis in this subgroup, predictors of outcome were hsCRP (P = 0.03) and raised troponin I (P = 0.02). nSTE-ACS in comparison to STE-ACS patients were more obese (BMI, P < 0.01), had higher LDL cholesterol (P < 0.01), fasting glucose (P = 0.03). LDL cholesterol (P = 0.02) and fasting glucose (P = 0.03) emerged as independent predictors of outcome in these patients. Mean follow-up period was 25.4 months. STE-ACS patients had twice fewer MACE rate than nSTE-ACS patients [(1-CD, 12-HA; 11%) vs (1-CD, 16-HA; 25%), respectively, log rank P < 0.01]. CONCLUSIONS STE-ACS and nSTE-ACS patients with normal coronary arteriography have different clinical profiles. In nSTE-ACS patients more pronounced metabolic abnormalities were identified, while in STE-ACS patients inflammatory background was more significant.
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Affiliation(s)
- Lukasz Mazurkiewicz
- Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland.
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50
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Wang J, Xing YW, Chen JX, He QY, Gao YH, Li Z. [Characteristics of coronary arteriography and traditional Chinese medicine syndrome of 1,069 patients with coronary artery disease]. ACTA ACUST UNITED AC 2008; 6:148-52. [PMID: 18241648 DOI: 10.3736/jcim20080208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To study the characteristics of coronary arteriography and traditional Chinese medicine syndrome of 1,069 patients with coronary artery disease (CAD). METHODS One thousand and sixty-nine patients with CAD were investigated by epidemiological method. The patients were divided into young patients (n=82, aged 45 years or younger) and middle-aged and old patients (n=987, older than 45 years). The characteristics of the two groups were analyzed, including clinical data, coronary arteriography and traditional Chinese medicine syndrome. RESULTS Compared with middle-aged and old patients, proportion of male, triglyceride, total cholesterol, smoking patients, acute myocardial infarction and family history of CAD in young patients were significantly higher (P<0.05). Patients accompanying with hypertension and diabetes in middle-aged and old patients were more than those in young patients (P<0.05). Occurrence rates of morbidity of left circumflex coronary artery, left main coronary artery and multi-branch were higher in middle-aged and old patients (P<0.05), however, the occurrence rates of morbidity of single and double-branch were higher in young patients (P<0.05). The occurrence rates of syndromes of qi stagnation and phlegm turbidity in young patients were higher than those in middle-aged and old patients (P<0.05). But the proportions of cold coagulation, yin deficiency, yang deficiency and kidney deficiency in middle-aged and old patients were obviously higher (P<0.05). CONCLUSION The traditional Chinese medicine syndrome and pathological changes of CAD in young patients are different from those in old patients.
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Affiliation(s)
- Jie Wang
- Department of Cardiology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
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