Myocardial Infarction in the Young

Wolfe, Mark W.; Vacek, James L.

doi:10.1378/chest.94.5.926

Cited by 98 publications

(49 citation statements)

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“…Given that young patients with ACS presented an average of 2 decades earlier than old patients and with fewer risk factors, it is conceivable that we observed less multivessel disease, less calcification, and fewer ostial lesions in young people compared with old people. There was a predilection for the presence of significant CAD in the left anterior descending artery in the young group, as previously documented 33, 34. An interesting observation is that the proportion of nonobstructive CAD was similar in the young women and men (15% versus 10%), but the mortality rate was higher in women.…”

Section: Discussionsupporting

confidence: 75%

Acute Coronary Syndrome: The Risk to Young Women

Ricci

Cenko

Vasiljević

et al. 2017

JAHA

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BackgroundAlthough acute coronary syndrome (ACS) mainly occurs in patients >50 years, younger patients can be affected as well. We used an age cutoff of 45 years to investigate clinical characteristics and outcomes of “young” patients with ACS.Methods and ResultsBetween October 2010 and April 2016, 14 931 patients with ACS were enrolled in the ISACS‐TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry. Of these patients, 1182 (8%) were aged ≤45 years (mean age, 40.3 years; 15.8% were women). The primary end point was 30‐day all‐cause mortality. Percentage diameter stenosis of ≤50% was defined as insignificant coronary disease. ST‐segment–elevation myocardial infarction was the most common clinical manifestation of ACS in the young cases (68% versus 59.6%). Young patients had a higher incidence of insignificant coronary artery disease (11.4% versus 10.1%) and lesser extent of significant disease (single vessel, 62.7% versus 46.6%). The incidence of 30‐day death was 1.3% versus 6.9% for the young and older patients, respectively. After correction for baseline and clinical differences, age ≤45 years was a predictor of survival in men (odds ratio, 0.24; 95% confidence interval, 0.10–0.58), but not in women (odds ratio, 1.35; 95% confidence interval, 0.50–3.62). This pattern of reversed risk among sexes held true after multivariable correction for in‐hospital medications and reperfusion therapy. Moreover, younger women had worse outcomes than men of a similar age (odds ratio, 6.03; 95% confidence interval, 2.07–17.53).Conclusion ACS at a young age is characterized by less severe coronary disease and high prevalence of ST‐segment–elevation myocardial infarction. Women have higher mortality than men. Young age is an independent predictor of lower 30‐day mortality in men, but not in women.Clinical Trial RegistrationURL: http://clinicaltrials.gov/. Unique identifier: NCT01218776.

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Section: Discussionsupporting

confidence: 75%

Acute Coronary Syndrome: The Risk to Young Women

Ricci

Cenko

Vasiljević

et al. 2017

JAHA

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“…It was shown in the PDAY study [16] and the Bogalusa Heart Study [17] that atherogenesis begins already in childhood, and the extent of lipid-rich plaques depends on such factors as age, non-high density lipoprotein cholesterol (HDL-C) level, hypertension, hyperglycaemia, obesity, and tobacco smoking. Prospective cohort studies including the Muscatine Study [18] and the Cardiovascular Risk in Young Finns Study [19] showed relations between coronary risk factors evaluated in childhood or early adulthood and the coronary calcium score or the carotid artery intima-media thickness, both surrogate markers of atherosclerosis during later life.…”

Section: Discussionmentioning

confidence: 99%

Clinical and angiographic characteristics of coronary artery disease in young adults: a single centre study

Maroszyńska-Dmoch

Wożakowska−Kapłon

2016

Kardiol Pol

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A b s t r a c tBackground: Coronary artery disease (CAD) in young adults under 40 years of age is a growing medical, social, psychological and economical problem, related to the prevalence of civilization-related diseases and unhealthy lifestyle. The problem of CAD in young people has not been characterised as well as in older individuals, as the available data mostly come from case reports and small series, often related to genetic aspects and familial occurrence of the disease. Aim:To assess clinical and angiographic characteristics of young adults with CAD and to evaluate in-hospital and long-term mortality in this patient group. The study combined a retrospective and a prospective approach.Methods: A total of 239 patients aged 40 years or younger who underwent coronary angiography (CAG) in the Swietokrzyskie Centre of Cardiology in Kielce in [2001][2002][2003][2004][2005][2006][2007][2008] were included in this study. Demographic characteristics, risk factor profile, laboratory test results, electrocardiographic and echocardiographic findings, CAG findings, and in-hospital mortality were assessed retrospectively in the selected groups. During the second stage of the study, clinical and mortality data were obtained prospectively in 130 patients (54.4% of the study group) during up to 5 years of follow-up. Results:The mean patient age was 35.1 ± 4.4 years. Men made up 86.2% of the study sample, and the proportion of rural area residents was 54.8%. Among young patients with acute coronary syndromes (ACS), the most common presentation (52.8%) was ST segment elevation myocardial infarction (STEMI). Angiographically normal coronary arteries were found in 37.2% of CAD patients and in 16.9% of patients with the diagnosis of ACS. The mean degree of coronary artery lumen stenosis was 75.4% in the group with significant atherosclerotic coronary lesions (50-90%) and 95.9% in the group demonstrating a critical coronary obstruction (≥ 90%). Single-vessel disease was identified in 61.9% of patients with a positive result of CAG (stenosis > 50%, CORO(+) group). The most common location of significant atherosclerotic coronary lesions was the left anterior descending artery (61.6%) followed by the right coronary artery (27.4%). The most prevalent conventional cardiovascular risk factors were lipid abnormalities, cigarette smoking and an increased body mass index ≥ 25 kg/m 2 , followed by a family history of CAD and hypertension. The proportion of patients with abnormal lipid profile, cigarette smoking and overweight or obesity was particularly high in the CORO(+) group (85.6%, 83.9%, and 64.4%, respectively). In-hospital mortality rate was low, at 0.7% among ACS patients. Long-term mortality during up to 5 years of follow-up was not so favourable, at 7.75% in ACS patients and 8.5% in the CORO(+) group. Conclusions:The population of young patients with CAD is predominantly male, rural, and characterised by a low socioeconomic status. The aetiology of CAD in this patient group differs significantly from that in older patients a...

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“…Studies of select cohorts of young patients with AMI have shown that young AMI patients have different demographics and risk factor profiles than older AMI patients. [8][9][10][11] For example, the majority of AMIs before age 40 occur in young men, as 81-94% of young AMI patients are male. [7][8][9][10][11][12] An increased number of risk factors are seen in younger AMI patients, with most young AMI patients (89-99%) having at least one cardiac risk factor.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11] For example, the majority of AMIs before age 40 occur in young men, as 81-94% of young AMI patients are male. [7][8][9][10][11][12] An increased number of risk factors are seen in younger AMI patients, with most young AMI patients (89-99%) having at least one cardiac risk factor. 7,9,10,12 Cigarette smoking is by far the most common risk factor in young AMI patients (62-94%), followed by family history of premature CAD (15-84%) and hyperlipidemia (20-61%).…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Young AMI patients have different risk factor profiles, less CAD by angiography, and better outcomes than older patients with AMI. [6][7][8][9][10][11][12][13][14] The lower incidence of CAD in patients under 40 and the differences in the characteristics of CAD in this age group make young patients with chest pain a distinct subgroup of patients. The purpose of this study was to describe the incidence of ACS in young chest pain patients, their clinical presentation, hospital course, and outcome at 30 days.…”

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confidence: 99%

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Characteristics and Outcomes of Young Adults Who Present to the Emergency Department with Chest Pain

Walker

Sites

Shofer

et al. 2001

Academic Emergency Medicine

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Abstract.Background: Most studies of emergency department (ED) chest pain patients exclude patients <30-40 years old. As a result, the clinical course of these patients is poorly described. Objective: To study the clinical characteristics, hospital course, and 30-day outcomes of ED chest pain patients <40 years old. The hypothesis was that patients <40 years old without a cardiac history and with normal electrocardiograms (ECGs) or no cardiac risk factors would be at a <1% risk for acute coronary syndromes (ACSs) and 30-day adverse cardiovascular (CV) events. Methods: This was a prospective cohort study of noncocaine-using ED patients, 24-39 years old, who received an ECG for chest pain between July 9, 1999, and October 23, 2000. Structured data collection at presentation included demographics, chest pain description, history, laboratory, and ECG data. Hospital course was followed daily. Thirty-day follow-up was performed by telephone. The main outcomes were discharge diagnosis and 30-day adverse CV events [acute myocardial infarction (AMI), death, percutaneous intervention (PCI), or coronary artery bypass grafting (CABG)]. Results: A total of 487 patients presented 527 times and comprised the study group. Patients were most often 30-39 years old (71%), female (60%), and African-American (73%). Thirty-two percent were admitted. Five hundred seven of 527 patient visits (96%) had 30-day follow-up. Patients had the following cardiac risk factors: tobacco, 37%; hypertension, 22%; family history, 19%; diabetes mellitus, 6%; cholesterol, 6%; prior angina, 3%; known coronary artery disease, 3%; and prior AMI, 2%. Patients usually had unremarkable ECGs (61% normal, 98% nonischemic). Overall, 11 of 527 patients had adverse CV events (2.1%; 95% CI = 0.9% to 3.3%): 8 AMIs (1.5%), 4 deaths (0.8%), 5 PCIs (0.9%), and no CABG. Twenty-five patients had a final diagnosis of ACS (4.7%; 95% CI = 2.9% to 6.5%). The incidence of ACS in the 210 patients without a cardiac history and without cardiac risk factors was 0.5% (95% CI = 0% to 1.4%). At 30 days, none of these 210 patients had AMI, PCI, CABG, or death (0%, 95% CI = 0% to 1.4%). The incidence of ACS in the 312 patients with normal ECGs and a negative cardiac history was 0.3% (95% CI = 0% to 0.9%). At 30 days, there was no AMI, PCI, or CABG in these 312 patients, and one patient with metastatic cancer died (adverse CV event 0.3%, 95% CI = 0% to 0.9%). Conclusions: Although young patients, as a whole, have a 4.7% risk of ACSs and a 2.1% risk of adverse CV events at 30 days, those without known cardiac disease or any cardiac risk factors had a <1% risk of ACSs and were free from adverse CV events over 30 days. Likewise, young patients without a cardiac history and with a normal ECG had a <1% risk of ACSs and adverse CV events at 30 days. It may be reasonable to expedite outpatient management and limit unnecessary admissions in these cohorts.

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Myocardial Infarction in the Young

Cited by 98 publications

References 15 publications

Acute Coronary Syndrome: The Risk to Young Women

Acute Coronary Syndrome: The Risk to Young Women

Clinical and angiographic characteristics of coronary artery disease in young adults: a single centre study

Characteristics and Outcomes of Young Adults Who Present to the Emergency Department with Chest Pain

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