Myocardial infarction in young adults

Egred, Mohaned; Viswanathan, Girish; Davis, Gershan

doi:10.1136/pgmj.2004.027532

Cited by 200 publications

(197 citation statements)

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“…Coronary angiography (CAG) more often shows normal coronary arteries, prompting for a search for non-atherosclerotic aetiology such as coronary spasm, vasculitis, embolism, or hypercoagulability. In young and very young subjects, destructive lifestyle factors have also been highlighted, including exaggerated ambitions, competition, workaholism, poor diet, use of psychoactive substances including cocaine, marijuana, and anabolic steroids, and disregarding early disease symptoms [5][6][7].…”

Section: Introductionmentioning

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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Section: Introductionmentioning

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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“…Se han descrito una serie de mecanismos por los cuales el uso de cocaína puede llevar a un IAM, dentro de los cuales se encuentran el vasoespamo coronario y un estado de hipercoagulabilidad 13 . Del mismo modo, el uso prolongado de esta droga también se ha asociado a fenómenos de aterosclerosis acelerada, por lo que no debiera extrañar la presencia de placas ateroscleróticas accidentadas en estos pacientes 14 . Al igual que en otras experiencias, encontramos que los pacientes jóvenes con IAM presentan menor carga de enfermedad coronaria, con Score de Syntax bajo y enfermedad de un vaso predominante (4,7).…”

Section: Discussionunclassified

Infarto Agudo Al Miocardio en Pacientes Menores De 40 Años: Caracteristicas Clínicas, Angiográficas Y Alternativas Terapéuticas

et al. 2013

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Recibido 23 de diciembre 2012 / Aceptado 12 de marzo 2013Objetivos: Analizar comparativamente las características clínicas y angiográficas, y el tratamiento utilizado, en pacientes jóvenes cursando un infarto agudo del miocardio (IAM) con supradesnivel del segmento ST (SDST).Métodos: Análisis retrospectivo de los pacientes que se presentaron con un IAM con SDST y fueron sometidos a angiografía coronaria durante el período entre enero de 2009 y diciembre de 2011. Se identificó a los pacientes menores de 40 años y se registraron sus características clínicas y angiográficas, las terapias utilizadas y sus resultados a mediano plazo. Estos datos fueron comparados con los pacientes de 40 o más años atendidos durante el mismo período.Resultados: De 613 IAM con SDST, 40 (6,5%) casos correspondieron a menores de 40 años (edad promedio 36,6 años). De éstos, 7 (17,5%) fueron mujeres, 32 (80%) fumadores y 17 (42,5%) referían uso de cocaína. La mayoría presentó alta carga trombótica (TIMI Thrombus Grade 4/5 en 87,5%), pero con enfermedad de baja severidad anatómica (Syntax Score promedio 13,1 (DE 5,8)). Treinta (75%) pacientes recibieron angioplastía con stent y 21 (52,5%) aspiración de trombos. El seguimiento tardío reveló 5 (12,5%) eventos mayores. Comparado con los pacientes mayores de 40 años, la mortalidad al año fue marcadamente inferior: 2,5% versus 12%, p<0,01.Conclusiones: En menores de 40 años con IAM con SDST, el tabaquismo, uso de cocaína, fueron los principales factores asociados. Aunque la enfermedad coronaria anatómica no fue severa, hubo una gran carga trombótica en la mayoría de los pacientes. Esto se asoció a escasos eventos cardiovasculares y una mortalidad menor a la de los pacientes mayores. Palabras claves:Infarto al miocardio, grupos poblacionales, abuso de cocaína.

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“…It has been shown, for example, that sex hormones can also dictate the expression of extracellular matrix and MMPs in the aorta [8,27]. The fact that the gender difference in the incidence of MI disappears after menopause [3] also supports this notion. In addition, it has been shown that the hormonal pattern directly affects ventricular remodeling after MI.…”

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confidence: 86%

“…The Framingham study, for example, has demonstrated that the incidence of acute MI is 2.5-fold higher in males than females before age 45, however, this gender difference disappears after 55 years of age [3]. Clinical studies indicate that the rate of acute mortality, including sudden death, in men is about twice that observed in women [4].…”

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confidence: 99%

Sex differences in myocardial infarction and rupture

Qiu

Depré

Vatner

et al. 2007

Journal of Molecular and Cellular Cardiology

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Although myocardial rupture occurs in a relatively low percentage (2-4%) of cases of acute myocardial infarction (MI), it is associated with an extremely high mortality rate due to cardiogenic shock (up to 90% in cases of free wall rupture and 50% of cases involving septal rupture), and it accounts for up to 25% of in-hospital death [1]. Understanding the molecular mechanisms leading to myocardial rupture therefore represents an important challenge for improving the short term prognosis of MI. In the present issue of the Journal, Fang and coauthors [2] investigate an intriguing aspect of the pathophysiology of this disease, which relates to the mechanisms underlying the gender differences in the rate of post-MI rupture.It is well documented that the incidence of acute MI varies according to both gender and age. The Framingham study, for example, has demonstrated that the incidence of acute MI is 2.5-fold higher in males than females before age 45, however, this gender difference disappears after 55 years of age [3]. Clinical studies indicate that the rate of acute mortality, including sudden death, in men is about twice that observed in women [4]. This poorer prognosis in men is also supported by the observation that myocardial rupture after MI is observed twice as often in men than in women [5]. The prognosis of MI is also usually worse in younger patients due to the absence of a history of chronic ischemia and secondary collateral development, and because an early MI is usually due to the accumulation of several risk factors, such as diabetes, smoking, metabolic syndrome and consumption of recreational drugs [6].These clinical observations of sex differences in the incidence and the prognosis of acute cardiovascular events correlate with several studies conducted in large mammals [7][8][9][10]. In a monkey model of aging, gender differences in gene and protein expression can explain several aspects of the characteristic protection of females against cardiovascular disease, including a better preservation with aging of the expression of enzymes of glycolytic and oxidative pathways [10], a better cardiovascular response to β-adrenergic stimulation [9], less apoptosis and myocyte hypertrophy in old female monkeys than in old male monkeys [11], as well as differences in the composition of the extracellular matrix of conductance vessels, such as elastin and collagen isoforms, which correlates with lower vascular stiffness in females compared to males [7,8]. Some of these differences between males and females are already present at a young age, especially for genes expressed on sex chromosomes, suggesting that gender differences in expression of genes and proteins in the cardiovascular system can already be programmed early in life [8]. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof be...

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Myocardial infarction in young adults

Cited by 200 publications

References 56 publications

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

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

Infarto Agudo Al Miocardio en Pacientes Menores De 40 Años: Caracteristicas Clínicas, Angiográficas Y Alternativas Terapéuticas

Sex differences in myocardial infarction and rupture

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