Myocardial Infarction at a Young Age (Under 40 Years)

Abstract

Coronary morphology, risk factors, long-term prognosis, and progression of coronary arteriosclerosis were investigated in 679 (649 mean and 30 women) post-infarction patients under 40 years of age. These patients represented 80% of 844 MI patients under 40 who were referred to our hospital in the years 1973-1980; 20% had refused coronary angiography; 465 patients were followed up for 1-7 years (mean 3.5 years). In 164 patients, a second coronary angiography was performed 3.8 years after the first angiogram, which was done an average 3 months after the acute episode. The main results were as follows: 8.4% of the patients had zero-vessel disease and 3.7% had a normal coronary angiogram. The majority had single-vessel disease (57.3%). The prevalence of zero-vessel disease decreased with age while that of multivessel disease increased. With increasing vessel involvement, the prevalence of hypercholesterolemia, hypertriglyceridemia, and hypertension increased. A history of smoking was equally common in patients with zero-, single-, double-, and triple-vessel disease. In women the combination of smoking and the use of oral contraceptive drugs was frequently seen. In one-quarter of the zero-vessel disease patients, the infarction occurred during unusually intense physical exercise. The statistical analysis of the survival data using the proportional hazards model (univariate analysis) showed the variables heart volume/body wt., ventricular arrhythmias, PCP at rest, PCP max, work capacity, ventricular function, and number of diseased vessels to be of prognostic importance. Multivariate analysis using this model revealed the following independent variables to be relevant to prognosis: heart volume/body wt., ventricular arrhythmias, ventricular function, and number of diseased vessels. After an average of 3.8 years since the first coronary angiography, 28.6% of the patients showed a significant progression of coronary arteriosclerosis (at least two degrees of stenosis according to the AHA classification). In the subgroup of patients with multilocular disease in the first angiogram, progression was 10 times as frequent as in a group with initial unilocular disease (34.3% vs 3.6%). Patients with progression had continued to smoke significantly more often than patients without progression (38.4%) vs 14.5%). Regression of coronary angiographic findings was significantly more frequent in the group of patients with initial unilocular disease than in those with multilocular disease in the first angiogram (28.6% vs 10.6%). Regression might be explained as recanalization and organization of a thrombus.(ABSTRACT TRUNCATED AT 400 WORDS)

Myocardial infarction in young adults under 30 years: Risk factors and clinical course

“…Roskamm et al (1984) found that of the 679 patients under the age of 40 with acute MI, 8.4% had normal coronary arteries, 57.3% had one-vessel disease, and 34.3% had multivessel disease. There was, however, a significant decrease in the prevalence of zero-vessel disease from those patients below 30 years to the group aged 35-39 years (Roskamm et al, 1984). Uhl and Farre11 (1983) found that 65% of their 81 young MI patients who underwent coronary angiography had multivessel disease, 24% one-vessel disease, and 11% normal coronary angiogram.…”

“…(1980) found that 27% of their patients with zero-vessel disease had exerted themselves to an extreme degree within 24 h preceding the MI, in contrast to 12% of patients with two-or three-vessel disease. Roskamm et al (1984) reported that the acute event was preceded by physical exercise in 60 (1 7%) of 350 patients in whom the relationship to exercise was evaluated. Preceding physical exercise was seen in about 25% of the patients with zero-vessel disease as compared to about 10% of the patients with one-to three-vessel disease (Roskamm et al, 1984).…”

“…Roskamm et al (1984) reported that the acute event was preceded by physical exercise in 60 (1 7%) of 350 patients in whom the relationship to exercise was evaluated. Preceding physical exercise was seen in about 25% of the patients with zero-vessel disease as compared to about 10% of the patients with one-to three-vessel disease (Roskamm et al, 1984). We found such exertion history in 10% of our patients, all with normal coronary angiograms.…”

Association between fibrinogen level and the severity of coronary stenosis in 418 male patients with myocardial infarction younger than 35 years old

“…Clinically, these patients are characterized by fewer coronary risk factors than older patients and a higher incidence of normal coronary angiography or single vessel disease [ 5 , 6 ]. The presence of normal coronary angiography is associated with coronary vasospasm, embolism from endocardium or heart vessels, platelet aggregation or spontaneous lysis of thrombus [ 7 ].…”

Managing and analysing a large health-care system database for predicting in-hospital mortality among acute myocardial infarction patients

“…Only 5% of myocardial infarctions occurring in males under the age of 65 are below 40 years of age. 19 In addition, advanced age has been associated with increased mortality following AMI in many large clinical trials, 20 while young patients entering the hospital have an excellent oneyear prognosis. 21 Similarly, with respect to the in-hospital mortality, the odds of in-hospital mortality increased about 2% with every additional year of the patients' age.…”