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Bęćkowski M, Kowalik I, Jaworski K, Dąbrowski R, Gierlotka M, Gąsior M, Poloński L, Zdrojewski T, Karwowski J, Drygas W, Szwed H. Differences in Symptomatology and Clinical Course of Acute Coronary Syndromes in Women ≤45 Years of Age Compared to Older Women. Curr Probl Cardiol 2019; 46:100508. [PMID: 31898981 DOI: 10.1016/j.cpcardiol.2019.100508] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/29/2019] [Accepted: 11/02/2019] [Indexed: 12/22/2022]
Abstract
Acute coronary syndromes (ACS) in young people are rare. The data regarding differences in symptoms in relation to age are scarce, which may have an influence on outcomes. The aim of this study was to evaluate the differences in the clinical course of ACS between younger women (≤45 years old) and older women (63-64 years old). We compared 7481 women with ACS from the Polish Registry of ACS between 2007 and 2014 (1834 women aged ≤45 years and 5647 women aged 63-64 years). The predominant symptom of ACS in both groups was chest pain, with a higher incidence occurring in younger women (90.4% vs 88.5%, P = 0.025). Prehospital cardiac arrest occurred more often in younger women (2.1% vs 0.8%, P < 0.001), and onset-to-balloon time was shorter (8.9 vs 15.2 hours, P < 0.0001) in this group. Younger women presented with a lower Killip class at admission (class I at admission: 92.7% vs 86.2%, P < 0.001). The dominant type of ACS in the younger cohort was ST-segment elevation myocardial infarction (STEMI) (42% vs 26.1%), localized mainly in the anterior wall (47.7% vs 36.1%, P < 0.001), with a higher percentage of total occlusion of infarct-related artery (TIMI 0, 45.2% vs 36.1%) and left anterior descending artery engagement for all (33.5% vs 26.5%, P < 0.001). Drug-eluting stents were often used in the younger patients (43.3% vs 38.2%, P = 0.003) without significant differences in percutaneous coronary intervention numbers. Pharmacotherapy was used less in younger women. The 30-day and 2-year mortality in young women was lower than in the older cohort. The clinical course of ACS in younger women differed in comparison to older women. Younger women had a higher occurrence of typical chest pain, STEMI, and left anterior descending artery engagement. Except STEMI patients young women received faster revascularization, however with no significant differences in invasive treatment. Pharmacotherapy was inadequate in younger women and that resulted in a lower usage of the beta-blockers, angiotensin-converting enzyme inhibitors, and statins in that group. Short- and long-term mortality was low, regardless of the type of ACS.
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Bęćkowski M, Gierlotka M, Gąsior M, Poloński L, Zdrojewski T, Dąbrowski R, Kowalik I, Karwowski J, Drygas W, Szwed H. Factors Affecting Early Mortality and 1-Year Outcomes in Young Women With ST-Segment-Elevation Myocardial Infarction Aged Less Than or Equal to 45 Years. Curr Probl Cardiol 2019; 46:100419. [PMID: 31047713 DOI: 10.1016/j.cpcardiol.2019.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/24/2019] [Accepted: 03/26/2019] [Indexed: 11/27/2022]
Abstract
Given that up to 2% of patients with myocardial infarction (MI) are young women, the purpose of this study was to evaluate factors affecting outcomes in young women with ST-segment-elevation myocardial infarction (STEMI) aged less than or equal to 45 years. We evaluated 796 women with STEMI aged less than or equal to 45 years between 2007 and 2014, and mortality was 4.0%. Death occurred more often in women with prehospital sudden cardiac arrest, and severe symptoms of heart failure; less commonly, the women were subjected to percutaneous coronary intervention (PCI), with a higher rate of incomplete revascularization. Beta blockers (BB) and angiotensin converting enzyme inhibitors were frequently used in the survivor group. The independent predictor of 30-day mortality was as follows: inability to undergo PCI (odds ratio [OR] 4.6, 95% confidence interval [CI] 1.45-14.76, P = 0.009), sudden cardiac arrest (OR 4.5, 95% CI 1.5-18.3, P = 0.04). An increase in systolic blood pressure for every 5 mm Hg was associated with lower mortality, OR 0.90, 95% CI 0.76-0.97 in patients without cardiogenic shock (CS) and OR 0.69, 95% CI 0.61-0.78, P < 0.0001 in the group with CS. Predictors for 1-year mortality were the inability to undergo PCI (hazard ratio [HR] 84, 95% CI 1.6-43.1, P = 0.01) and CS (HR 6.97, 95% CI 1.39-34.7, P = 0.01). An increase of 5% in left ventricular ejection fraction reduced the mortality rate for 60% (HR 0.40, 95% CI 0.26-0.63, P < 0.0001) and an increase in systolic blood pressure for every 5 mm Hg reduced mortality for 34% (HR 0.66, 95% CI 0.52-0.84, P = 0.02). Both short- and long-term outcomes in young women aged less than or equal to 45 years with STEMI are good. The strongest predictor for both 30-day and 1-year mortality was the inability to undergo PCI. Suboptimal use of beta blockers and angiotensin converting enzyme inhibitors affect the outcomes in young women. Hypotension in the acute phase of MI increased mortality in young women, independent of coexisting CS.
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Bęćkowski M, Gierlotka M, Gąsior M, Poloński L, Zdrojewski T, Dąbrowski R, Karwowski J, Kowalik I, Drygas W, Szwed H. Risk factors predisposing to acute coronary syndromes in young women ≤45 years of age. Int J Cardiol 2018; 264:165-169. [PMID: 29655953 DOI: 10.1016/j.ijcard.2018.03.135] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Revised: 03/27/2018] [Accepted: 03/30/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Acute coronary syndromes (ACS) are rare in young women. The purpose of this study was to characterize risk factors (RF) predisposing to ACS in young women and evaluate possible age-related differences. METHODS AND RESULTS We studied 1941 young women with ACS aged ≤45 years (≤45ACS) from the PL-ACS registry and compared them with two control groups: 4275 women aged 63-64 years with ACS (63-64ACS) from the PL-ACS registry and 1170 young healthy women aged ≤45 years (≤45H) without confirmed coronary artery disease (CAD), from two national, representative, cross-sectional population health surveys, NATPOL 2011 and WOBASZ. The prevalence of major RF in these three groups was as follows, respectively: (≤45 ACS vs. 63-64ACS vs. ≤45H, for all P < 0.0001): hypertension 49.8% vs. 78.1% vs. 16.8%; hypercholesterolemia 36.1% vs. 44.3% vs. 12.9%; obesity 22.3% vs. 28.1% vs. 15.6%; diabetes 10.6% vs. 29.9% vs. 1.8% and smoking 48.7% vs. 22.2% vs. 39%. Healthy women had the lowest number of major RF (1.7 ± 1.2 vs. 2.0 ± 1.1 vs. 1.1 ± 1.0). No RF was found in 16.7% vs. 8.2% vs. 34.4% women, respectively. Independent predictors of ACS in the ≤45ACS group included diabetes [odds ratio (OR) 6.66, 95% confidence interval (CI) 3.47-12.74]*, hypertension (OR 4.30, 95% CI 3.42-5.38)*, hypercholesterolemia (OR 3.45; 95% CI 2.60-4.29)*, and smoking (OR 1.63, 95% CI 1.34-1.98)*, *(P < 0.0001 for all). CONCLUSIONS The prevalence of risk factors for acute coronary syndromes in young women with ACS is different to those in healthy women and to those in older women. The prevalence of smoking was higher. The strongest predictor of ACS in women ≤45 years of age was diabetes, with a 6-fold increase in risk. There is still need to improve the cardio-vascular primary prevention and health promotion in the population of young women.
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Affiliation(s)
- Maciej Bęćkowski
- 2nd Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland.
| | - Marek Gierlotka
- 3rd Department of Cardiology, School of Medicine with The Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mariusz Gąsior
- 3rd Department of Cardiology, School of Medicine with The Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Lech Poloński
- 3rd Department of Cardiology, School of Medicine with The Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Tomasz Zdrojewski
- Department of Preventive Medicine and Education, Medical University of Gdańsk, Gdańsk, Poland; National Institute of Public Health - National Institute of Hygiene (NIPH - NIH), Warsaw, Poland
| | - Rafał Dąbrowski
- 2nd Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Jarosław Karwowski
- 2nd Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Ilona Kowalik
- 2nd Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Wojciech Drygas
- Department of Epidemiology, Cardiovascular Disease Prevention and Health Promotion, Institute of Cardiology, Warsaw, Poland
| | - Hanna Szwed
- 2nd Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
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Karwowski J, Gierlotka M, Gąsior M, Poloński L, Ciszewski J, Bęćkowski M, Kowalik I, Szwed H. Relationship between infarct artery location, acute total coronary occlusion, and mortality in STEMI and NSTEMI patients. Pol Arch Intern Med 2017; 127:401-411. [PMID: 28475171 DOI: 10.20452/pamw.4018] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The prevalence of total coronary occlusion of an infarct‑related artery (IRA) and its impact on the outcome can differ between patients with non‑ST‑elevation myocardial infarction (NSTEMI) and those with ST‑segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention (PCI). OBJECTIVES We evaluated the impact of IRA occlusion on the outcome of myocardial infarction according to the presence or absence of ST‑segment elevation and the location of the culprit lesion. PATIENTS AND METHODS We analyzed 4581 patients with STEMI and 2717 patients with NSTEMI who underwent PCI and were enrolled in the Polish Registry of Acute Coronary Syndromes. Patients were divided into 3 cohorts depending on the IRA: left anterior descending artery (LAD), left circumflex artery (LCx), or right coronary artery (RCA). Patients were further divided according to preprocedural Thrombolysis in Myocardial Infarction (TIMI) flow to either a subgroup with total occlusion (TO; TIMI flow grade, 0) or a subgroup with incomplete occlusion (nTO; TIMI flow grade ≥1). RESULTS TO was observed in 2949 patients (64.4%) with STEMI and 723 patients (26.6%) with NSTEMI. The most common IRAs were the RCA (49.4%) and LCx (48.4%) in the STEMI and NSTEMI groups, respectively. STEMI patients with TO of the LAD showed higher mortality during the 36‑month follow‑up; mortality in the NSTEMI group was comparable between patients with TO and nTO. STEMI and NSTEMI groups with TO of the LCx showed higher in‑hospital mortality. No differences were observed between patients with TO and nTO of the RCA. CONCLUSIONS Totally occluded IRA (TIMI flow grade 0) on baseline angiogram was not associated with higher 36‑month mortality rates after both NSTEMI and STEMI treated with PCI in comparison with patients with patent IRA except for totally occluded LAD in STEMI.
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Karwowski J, Poloński L, Gierlotka M, Ciszewski A, Hawranek M, Bęćkowski M, Gąsior M, Kowalik I, Szwed H. Total coronary occlusion of infarct-related arteries in patients with non-ST-elevation myocardial infarction undergoing percutaneous coronary revascularisation. Kardiol Pol 2017; 75:108-116. [DOI: 10.5603/kp.a2016.0130] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Revised: 06/08/2016] [Accepted: 07/13/2016] [Indexed: 11/25/2022]
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Karwowski J, Poloński L, Gierlotka M, Gąsior M, Bęćkowski M, Kowalik I, Szwed H. Post-procedural TIMI flow grade 2 is not associated with improved prognosis in patients with non-ST-segment elevation myocardial infarction undergoing percutaneous coronary revascularization (PL-ACS registry). Cardiol J 2016; 23:402-10. [DOI: 10.5603/cj.a2016.0025] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2015] [Revised: 06/10/2016] [Accepted: 05/24/2016] [Indexed: 11/25/2022] Open
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Ciszewski A, Sosnowski C, Bęćkowski M, Karwowski J. Occlusion of the left anterior descending coronary artery following a negative fractional flow reserve study. Failure or limit of a "gold standard" method? Kardiol Pol 2016; 74:83. [PMID: 26832812 DOI: 10.5603/kp.2016.0010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 04/15/2015] [Indexed: 11/25/2022]
Affiliation(s)
- Andrzej Ciszewski
- Department of Invasive Cardiology, Institute of Cardiology, Warsaw, Poland.
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Karwowski J, Bęćkowski M, Szwed H, Ciszewski A. Acute coronary syndrome in a 100-year-old woman treated successfully with primary percutaneous coronary angioplasty. Postepy Kardiol Interwencyjnej 2013; 9:179-83. [PMID: 24570714 PMCID: PMC3915969 DOI: 10.5114/pwki.2013.35456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 04/15/2013] [Accepted: 05/09/2013] [Indexed: 11/17/2022] Open
Abstract
We present a case of a 100-year-old woman living alone with ST-elevation myocardial infarction acute coronary syndrome of the infero-lateral wall treated with percutaneous coronary intervention. Coronary angiography revealed critical 99% stenosis in the marginal branch of the circumflex artery and insignificant lesions in other arteries. Two bare metal stents were implanted successfully in the same session. The patient was discharged home in good general condition, able to live and function independently.
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Affiliation(s)
- Jarosław Karwowski
- 2 Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Maciej Bęćkowski
- 2 Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Hanna Szwed
- 2 Department of Coronary Artery Disease, Institute of Cardiology, Warsaw, Poland
| | - Andrzej Ciszewski
- Department of Invasive Cardiology, Institute of Cardiology, Warsaw, Poland
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Bęćkowski M, Szwed H. Coronary artery disease seen from the angle of psoriasis. Kardiol Pol 2013; 71:517-21. [DOI: 10.5603/kp.2013.0101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2013] [Indexed: 11/25/2022]
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