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Background Why do some patients suffer acute myocardial ( ) infarction MI despite angiographically normal coronary arteries ( ) NL+ MI whereas others enjoy an acute MI-free life despite ( ) extensive three-vessel disease 3VD-MI ? The present study contrasts these two groups to identify some differences in the risk profile. MethodsIn 10 000 patients admitted to the cardiology service, a first MI was confirmed in 2356 patients, of whom 1609 underwent coronary angiography. In 77 patients with MI, ( coronary angiography was found to be entirely normal NL+ MI, ) 77/ 1609, 4.1% . These were contrasted to 123 patients with ( ) severe three-vessel coronary disease but no MI 3VD-MI .( Results Patients with NL+ MI were 13 years younger 42" 8.3 ) ( ) vs 55" 10.5, P -0.05 , with 33 patients 43% under the ( ) age 40 years, in contrast to only 9 patients 7.3% in the 3VD group being this age. Patients with NC + MI were more often ( ) current smokers 80.5% vs 29% in the 3VD group; P -0.01 . Patients with 3VD-MI were, on the other hand, more often ( ) diabetic 54% vs 9% in the NL+ MI group; P -0.01 and had ( a higher cholesterol level 5.6" 1.1 vs 4.9" 1.0 Mmol / l, ) P -0.01 as well as a higher incidence of chronic stable ( ) ( angina 52% vs 22%; P -0.01 and heart failure 6% ) compared with 0% in the NL+ MI group . Sixty-one out of 77 ( ) 79% NL+ MI patients had a single risk factor, and in 87%, this was smoking alone. Diabetes mellitus was rare and never occurred alone in this group. ConclusionIn patients who suffer MI despite normal coronary angiography, smoking is a major risk factor: In contrast, in patients with extensive coronary artery disease on angiography but no MI, diabetes rather than smoking is the dominant risk factor. The findings of this study support the view that the risk factors for stable and unstable coronary artery disease are different, as reflected by the contrast of the above groups at the extremes of the spectrum. Smoking appears to be a major ( risk factor for acute MI even with normal coronary ) angiography , whereas diabetes is a major risk factor for more severe but more stable coronary artery disease.

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