Acute myocardial infarction in the young adults

Comparison of Long-Term Mortality of Patients Aged ≤40 Versus >40 Years With Acute Myocardial Infarction

Young patients with acute myocardial infarction (MI) have a more favorable prognosis than older patients with MI. However, there are limited data comparing the prognosis of young patients with MI with young population controls. Comparison with an age-matched background population could unmask residual mortality risk in young patients with MI that would otherwise not be apparent when merely comparing the mortality risk of young and older patients with MI. We studied 15,151 patients with AMI from 2000 to 2005, of which 601 patients were ≤40 years (young MI). The relative survival ratio (RSR) was calculated as the ratio of the observed survival of patients with MI divided by the expected survival, estimated from the background population (n = 3,771,700) matched for age, gender, and follow-up year. An RSR of <1.0 or >1.0 indicates poorer or better survival, respectively, than the background population. The 12-year all-cause and cardiovascular mortality of young versus older patients was 12.8% versus 50.7% (p <0.001) and 9.2% versus 34.5% (p <0.001), respectively. The adjusted hazard ratio (95% confidence interval) for all-cause and cardiovascular mortality comparing young with older patients was 0.20 (0.16 to 0.27) and 0.27 (0.20 to 0.36), respectively. The RSR (95% confidence interval) of young and older patients was, respectively, 0.969 (0.950 to 0.980) and 0.804 (0.797 to 0.811) at 1 year, 0.942 (0.918 to 0.960) and 0.716 (0.707 to 0.726) at 5 years, and 0.908 (0.878 to 0.938) and 0.638 (0.620 to 0.654) at 9 years. In conclusion, despite a fivefold lower long-term mortality than older patients with MI, young patients with MI remain at significantly greater risk of long-term mortality than an age-matched background population.

Clinical characteristics and long-term progression of young patients with acute coronary syndrome in Brazil

Objective

In Brazil, there are few descriptions in the literature on the angiographic pattern and clinical characteristics of young patients with acute coronary syndrome, despite the evident number of cases in the population. The objective of this study was to evaluate which clinical characteristics are most closely related to the acute coronary syndrome in young patients, and what long-term outcomes are in this population.

Methods

This is a prospective observational study with 268 patients aged under 55 years with acute coronary syndrome, carried out between May 2010 and May 2013. Data were obtained on demographics, laboratory test and angiography results, and the coronary treatment adopted. Statistical analysis was presented as percentages and absolute values.

Results

Approximately 57% were men and the median age was 50 years (30 to 55). The main risk factors were arterial hypertension (68%), smoking (67%), and dyslipidemia (43%). Typical pain was present in 90% of patients. In young individuals, 25.7% showed ST segment elevation. Approximately 56.5% of patients presented with a single-vessel angiographic pattern. About 7.1% were submitted to coronary bypass surgery, and 42.1% to percutaneous coronary angioplasty. Intrahospital mortality was 1.5%, and the combined event rate (cerebrovascular accident/stroke, cardiogenic shock, reinfarction, and arrhythmias) was 13.8%. After a mean follow-up of 10 months, mortality was 9.8%, while 25.4% of the patients had new ischemic events, and 37.3% required readmission to hospital.

Conclusion

In the short-term, young patients presented with mortality rates below what was expected when compared to the rates noted in other studies. However, there was a significant increase in the number of events in the 10-month follow-up.

A 16-year-old with ST elevation myocardial infarction: case report and review of the literature

Chest pain in young adults presents a unique diagnostic challenge, placing young patients at an increased risk to be misdiagnosed, as this patient population typically does not demonstrate the traditional risk factors associated with cardiovascular disease. This study details the case of a 16-year-old male who presented with new-onset chest pain and ST elevation on electrocardiogram. His history was unremarkable for known cardiac risk factors, but laboratory evaluation demonstrated markedly elevated troponins and electrocardiographic findings confirmed ST-segment elevation myocardial infarction. Coronary angiography demonstrated 100% occlusion of the left anterior descending artery, which was managed with percutaneous transluminal coronary angioplasty, thrombectomy, and bare-metal stenting. The patient had an uneventful recovery. This study examines the major causes of ST elevation myocardial infarction in young adults and reviews the major differences between younger and older myocardial infarction populations with emphasis on risk factor profile, pathophysiological mechanisms, clinical presentation, angiographic findings, and prognosis. This review highlights the need for consideration of a wide differential in younger subsets of the population presenting with chest pain and ST elevation. The implementation of current adult management protocols and guidelines for ST elevation myocardial infarction should not be overlooked due to age. Given the potential for premature death and long-term disability with resulting individual and societal consequences, it is crucial to understand the importance of correct diagnostic evaluation in this clinical scenario.

Young coronary artery disease in patients undergoing percutaneous coronary intervention

BACKGROUND AND OBJECTIVES

Understanding the nature and pattern of young coronary artery disease (CAD) is important due to the tremendous impact on these patients' socio-economic and physical aspect. Data on young CAD in the southeast Asian region is rather patchy and limited. Hence we utilized our National Cardiovascular Disease Database (NCVD)-Percutaneous Coronary Intervention (PCI) Registry to analyze young patients who underwent PCI in the year 2007 to 2009.

DESIGN AND SETTINGS

This is a retrospective study of all patients who had undergone coronary angioplasty from 2007 to 2009 in 11 hospitals across Malaysia.

METHODS

Data were obtained from the NCVD-PCI Registry, 2007 to 2009. Patients were categorized into 2 groups-young and old, where young was defined as less than 45 years for men and less than 55 years for women and old was defined as more than or equals to 45 years for men and more than or equals to 55 years for women. Patients' baseline characteristics, risk factor profile, extent of coronary disease and outcome on dis.charge, and 30-day and 1-year follow-up were compared between the 2 groups.

RESULTS

We analyzed 10268 patients, and the prevalence of young CAD was 16% (1595 patients). There was a significantly low prevalence of Chinese patients compared to other major ethnic groups. Active smoking (30.2% vs 17.7%) and obesity (20.9% vs 17.3%) were the 2 risk factors more associated with young CAD. There is a preponderance toward single vessel disease in the young CAD group, and they had a favorable clinical outcome in terms of all-cause mortality at discharge (RR 0.49 [CI 0.26-0.94]) and 1-year follow-up (RR 0.47 [CI 0.19-1.15]).

CONCLUSION

We observed distinctive features of young CAD that would serve as a framework in the primary and secondary prevention of the early onset CAD.

Different clinical presentations in chinese people with acute myocardial infarction in the emergency department

BACKGROUND

The purpose of this study was to investigate the clinical characteristics of younger- (<or = 45 years old) and older-aged (> 45 years) Chinese patients presenting to the emergency department (ED) with an initial acute myocardial infarction (AMI).

METHODS

A retrospective review of 372 patients who had suffered an AMI (134 younger-aged, 238 older-aged), from 2,858 suspected AMI or ischemia patients during the period January 1996 to June 2003 inclusive, was conducted. Only patients who were diagnosed with AMI and who had been admitted to our institution's ED were enrolled into this study.

RESULTS

The incidence of AMI for individuals who were < or = 45 years old was approximately 12.3% of those admitted to hospital under the impression of AMI. The percentage of males was more predominant in the younger-aged group (p < 0.01). Regarding major risk factors for coronary artery disease (CAD), younger patients were more likely to have a family history of cardiac disease (p < 0.01), obesity with an elevated body mass index (26.2 +/- 4.1 vs. 24.2 +/- 3.7, p < 0.01),and hyperlipidemia (p < 0.01) when compared to the older-aged patients, who were more likely to suffer from hypertension (p < 0.01) and/or diabetes mellitus than their younger-aged counterparts (p < 0.01). Younger patients also featured a higher incidence of single-vessel CAD (p = 0.05), an insignificant rate of CAD (p = 0.02), and a lower rate of triple-vessel CAD (p = 0.03).

CONCLUSION

For Chinese, male gender and incidences of chest pain, positive family history of heart disease, obesity and hyperlipidemia were significantly greater in the younger-aged AMI patient group than in the older-aged AMI patient group. Younger-aged patients also had a greater rate of single-vessel CAD but a lower rate of triple-vessel CAD than older-aged patients.

Anaesthetic management of acute myocardial infarction during labour

Coronary artery disease is rarely detected during labour and the puerperium. We report the case of a 31-year-old primigravida at 38 weeks of gestation with hypercholesterolaemia and a family history of coronary heart disease, who presented with septal acute myocardial infarction. We decided to perform a caesarean section under general anaesthesia. The patient was later admitted to the intensive care unit. There were no complications during or after surgery. Cardiac ultrasound showed septal hypokinesia with normal systolic function and coronary angiography revealed normal coronary vessels. She remained haemodynamically stable and was discharged from intensive care 48 h later.

Acute myocardial infarction in the young--The University of Michigan experience

BACKGROUND

The purpose of this study was to assess frequency, risk factors, treatment, and complications of very young patients with acute myocardial infarction (MI) at the University of Michigan Medical Center (UMMC).

METHODS

From a database of 976 consecutive patients admitted to the UMMC with acute MI between 1995 and 1998, we compared care and outcomes of patients divided into 3 age categories: <46 years, 46-54 years, and >54 years. Risk factors, presenting symptoms, type of MI, management, complications, and hospital outcomes of the 3 groups were evaluated.

RESULTS

Young patients represented >10% of all patients with acute MI, and >25% of these individuals were women, a number considerably higher than seen in previous studies. This group of young patients was more likely to have Q-wave MI and risk factors such as family history and tobacco use and less likely to have a history of angina. Although all 3 groups received similar inpatient treatment, there was more attention paid to risk factor modification such as smoking cessation and referral to cardiac rehabilitation in younger individuals. Young patients had fewer in-hospital complications and a lower mortality rate.

CONCLUSIONS

At the University of Michigan, >1 in 10 with acute MI is <46 years old. Data suggest that current management and aggressive risk factor modification are quite good in this particular group, and overall the mortality rate is very low.

Myocardial infarction in young patients

Myocardial infarction in persons under the age of 45 years accounts for 6% to 10% of all myocardial infarctions in the United States. In this age group, it is predominantly a disease of men. Important risk factors include a family history of myocardial infarction before age 55 years, hyperlipidemia, smoking, and obesity. Unlike older patients, approximately half of young patients have single-vessel coronary disease, and in up to 20%, the cause is not related to atherosclerosis. Coronary angiography may be warranted in young patients with myocardial infarction to define the anatomy of the disease and to permit optimal management.

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

Sixty patients less than 35 years with a first Q wave acute myocardial infarction were prospectively studied to evaluate their features, risk factors and evidence of any viral infection. Typical chest pain was present in 98.3% with Q waves and ST segment elevation in all. None had hypotension or cardiogenic shock. Smoking was the most common risk factor (81.7%). Mean total cholesterol was 5.74 (+/-1.42) mmol/l. History of a viral illness was present in 28.3%, severe emotional stress in 21.7% and exhausting physical activity in 18.3%. Mean left ventricular diastolic and end systolic volumes were increased (90.11+/-22.5 ml/m2) and (46.62+/-20.46 ml/m2), respectively. The ejection fraction was depressed (49.71+/-1.6%). Triple vessel disease was seen only in 6.8 and 26.7% had insignificant or no coronary artery disease. Left anterior descending artery was most frequently involved (66%). None had left main involvement. Coronary ectasia was present in 11.7%, intracoronary thrombus in 28.3% and 40% had collaterals. Patients with no significant disease had no diabetes, a smaller number had a raised total cholesterol or smoked and had a lower ejection fraction. Patients from the Indian subcontinent who had fewer conventional risk factors, had more severe disease than those from the Arab world suggesting that other etiological factors need investigation.