Clinical and angiographic features in patients under 35 years with a first Q wave acute myocardial infarction

Lipoprotein(a): An underrecognized genetic risk factor for malignant coronary artery disease in young Indians

Malignant coronary artery disease (CAD) refers to a severe and extensive atherosclerotic process involving multiple coronary arteries in young individuals (aged <45 years in men and <50 years in women) with a low or no burden of established risk factors. Indians, in general, develop acute myocardial infarction (AMI) about 10 years earlier; AMI rates are threefold to fivefold higher in young Indians than in other populations. Although established CAD risk factors have a predictive value, they do not fully account for the excessive burden of CAD in young Indians. Lipoprotein(a) (Lp(a)) is increasingly recognized as the strongest known genetic risk factor for premature CAD, with high levels observed in Indians with malignant CAD. High Lp(a) levels confer a twofold to threefold risk of CAD-a risk similar to that of established risk factors, including diabetes. South Asians have the second highest Lp(a) levels and the highest risk of AMI from the elevated levels, more than double the risk observed in people of European descent. Approximately 25% of Indians and other South Asians have elevated Lp(a) levels (≥50 mg/dl), rendering Lp(a) a risk factor of great importance, similar to or surpassing diabetes. Lp(a) measurement is ready for clinical use and should be an essential part of all CAD research in Indians.

Coronary Artery Disease in Patients Aged 35 or less - A Different Beast?

Aim:

To assess the extent and severity of coronary artery disease (CAD) in 200 consecutive patients aged 35 years or less undergoing diagnostic coronary angiography.

Patients and Methods:

Findings in these 200 patients (≤ 35 years of age) were analyzed to find the extent and severity of CAD. The mean age was 31.69 (±3.76) years. Majority were males (94%) and from the Arab ethnicity (70.5%).

Result:

Smoking (71%) and history of premature CAD (27%) were the most frequent risk factors (RF). History of previous ST elevation myocardial infarction (MI) was present in 68%. Anterior wall MI was the most frequent location (63.3%). The majority (54.3%) had moderate or large size MI. Ejection fraction (EF) less than 50% was noted in 30.3%. Left main or triple vessel CAD was seen in 15%. One- and two-vessel CAD was seen in 32.5% and 19% patients, respectively. Coronary angiogram was completely normal in 23.5%. The majority (54.5%) were treated conservatively and the rest (45.5%) needed percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The mean number of stents used was 1.3 ± 0.67 and the mean length of stents used was 20.3 ± 12.6 mm.

Conclusion:

The extent and severity of CAD was very significant in this subgroup of very young (≤35 years) Asian patients. Smoking was the main risk factor and half of the patients needed either PCI or CABG.

Impact of Diabetes and Smoking Epidemic in the Middle East on the Presentation With Acute Coronary Syndrome in Very Young Patients

We describe the baseline characteristics, management, and outcomes of acute coronary syndrome (ACS) in patients of age ≤40 in the Gulf region of the Middle East. We studied 8176 hospitalized patients (≤40 years) with ACS. Ten percent (805) of the recruited patients were ≤40 years. The mean age was 37 years and 89% were males. The prevalence of smoking and diabetes in the young patients was high (58% and 21%, respectively). The most common ACS was ST elevation myocardial infarction. Younger patients were more aggressively treated with more frequent use of glycoprotein inhibitors, thrombolytics, and primary percutaneous coronary intervention. They had less in-hospital heart failure, left ventricular dysfunction, shock, stroke, and low rate of in-hospital mortality (1%). Measures to combat the rising prevalence of diabetes and smoking are needed.

Myocardial reinfarction in a patient with coronary ectasia

A 47-year-old male patient was admitted to our Emergency Hospital's coronary unit with an acute myocardial infarction, localized inferolaterally. He had been hospitalized 2 months before this occurrence because of persistent chest pain accompanied by elevation of the ST segment in precordial and inferior leads, for which he received thrombolytic therapy. Selective cardiac catheterization was then also effected, and showed diffuse ectasia of coronary arteries with no significant stenoses. Since streptokinase had been applied recently, the patient was given standard therapy as well as electroshocks because of chamber fibrillation. Two hours after admission, the infarct pain ceased and rapid ECG improvement occurred. Repeated coronarography showed a situation identical to the previous one. The patient was sent home to proceed with drug therapy.