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Ahmadloo S, Ling KH, Fazli A, Larijani G, Ghodsian N, Mohammadi S, Amini N, Hosseinpour Sarmadi V, Ismail P. Signature pattern of gene expression and signaling pathway in premature diabetic patients uncover their correlation to early age coronary heart disease. Diabetol Metab Syndr 2022; 14:107. [PMID: 35906673 PMCID: PMC9336005 DOI: 10.1186/s13098-022-00878-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 07/21/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronary Heart Disease (CHD) is the leading cause of death in industrialized countries. There is currently no direct relation between CHD and type 2 diabetes mellitus (T2D), one of the major modifiable risk factors for CHD. This study was carried out for genes expression profiling of T2D associated genes to identify related biological processes/es and modulated signaling pathway/s of male subjects with CHD. METHOD the subjects were divided into four groups based on their disease, including control, type 2 diabetes mellitus (T2D), CHD, and CHD + T2D groups. The RNA was extracted from their blood, and RT2 Profiler™ PCR Array was utilized to determine gene profiling between groups. Finally, the PCR Array results were validated by using Q-RT-PCR in a more extensive and independent population. RESULT PCR Array results revealed that the T2D and T2D + CHD groups shared 11 genes significantly up-regulated in both groups. Further analysis showed that the mRNA levels of AKT2, IL12B, IL6, IRS1, IRS2, MAPK14, and NFKB1 increased. Consequently, the mRNA levels of AQP2, FOXP3, G6PD, and PIK3R1 declined in the T2D + CHD group compared to the T2D group. Furthermore, in silico analysis indicated 36 Gene Ontology terms and 59 signaling pathways were significantly enriched in both groups, which may be a culprit in susceptibility of diabetic patients to CHD development. CONCLUSION Finally, the results revealed six genes as a hub gene in altering various biological processes and signaling pathways. The expression trend of these identified genes might be used as potential markers and diagnostic tools for the early identification of the vulnerability of T2D patients to develop premature CHD.
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Affiliation(s)
- Salma Ahmadloo
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
- Vaccination Department, Pasteur Institute of Iran, Tehran, Iran
| | - King-Hwa Ling
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
- Genetics and Regenerative Medicine Research Center, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Ahmad Fazli
- Department of Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - Ghazaleh Larijani
- Department of Biology, Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Nooshin Ghodsian
- Department of Biomedical Engineering, University of British Columbia, Vancouver, Canada
| | - Sanaz Mohammadi
- Faculty of Biological Science and Technology, Shahid Beheshti University, Tehran, Iran
| | - Naser Amini
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
- Institutes of Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Vahid Hosseinpour Sarmadi
- Cellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Institutes of Regenerative Medicine, Faculty of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Patimah Ismail
- Department of Biomedical Science, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia.
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Database Analysis on the Relationships Between Nonsteroidal Anti-inflammatory Drug Treatment Variables and Incidence of Acute Myocardial Infarction in Japanese Patients with Osteoarthritis and Chronic Low Back Pain. Adv Ther 2021; 38:1601-1613. [PMID: 33544304 PMCID: PMC7932944 DOI: 10.1007/s12325-021-01629-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 01/15/2021] [Indexed: 12/26/2022]
Abstract
Introduction We aimed to analyze the relationships between nonsteroidal anti-inflammatory drug (NSAID) treatment variables and the incidence of acute myocardial infarction (AMI) in Japanese patients with osteoarthritis (OA) and chronic low back pain (CLBP) using the data from a large-scale, real-world database. Methods We retrospectively analyzed anonymized claims data from the Japanese Medical Data Center of medical insurance beneficiaries who were prescribed NSAIDs for OA and/or CLBP from 2009 to 2018. Results Of 180,371 patients, 89.3% received NSAIDs as first-line analgesics (oral, 90.3%; patch, 80.4%; other transdermal drugs, 24.0%). Incidence of AMI was 10.27 per 10,000 person-years (95% confidence interval 9.20–11.34) in the entire study population. There was a trend towards increased risk in patients using NSAIDs for more than 5 years (P = 0.0784) than in those using NSAIDs for less than 1 year. Risk of AMI significantly increased with age and comorbidities of diabetes and cardiovascular disease (CVD). The risk for AMI was similar for patients who consistently used NSAIDs compared to those using them intermittently and patients who used patch compared to oral NSAIDs. Elderly patients used NSAIDs more consistently and used NSAID patches more frequently. Conclusion In Japanese patients with OA and CLBP, we saw a trend of increased risk for AMI in patients using NSAIDs for more than 5 years. Elderly patients had a higher prevalence of diabetes, hypertension, and other CVD which increased the risk of AMI. Although NSAID patches were preferred to oral NSAIDs in elderly patients, risk for AMI was similar between the two modalities. Therefore, we suggest using NSAIDs carefully, especially in elderly patients and those at risk of developing CVD. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-021-01629-6.
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Jamil S, Jamil G, Mesameh H, Qureshi A, AlKaabi J, Sharma C, Aziz F, Al-Shamsi AR, Yasin J. Risk factor comparison in young patients presenting with acute coronary syndrome with atherosclerotic coronary artery disease vs. angiographically normal coronaries. Int J Med Sci 2021; 18:3526-3532. [PMID: 34522179 PMCID: PMC8436094 DOI: 10.7150/ijms.60869] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/07/2021] [Indexed: 01/09/2023] Open
Abstract
Background: Acute myocardial infarction is a relatively rare phenomenon in the young population. The incidence has nevertheless increased from years past, likely due to the presence of multiple risk factors from an increasingly younger age. Regardless of whether they have atherosclerotic coronary artery disease or normal coronary angiogram, young patients with risk factors for coronary artery disease (CAD), chest pain, and positive troponin, are initially treated in a similar fashion. Our goal was to shed light on whether risk factors between these two groups differ to help guide physicians in clinically determining whether or not an atherosclerotic cardiovascular event has occurred, as well as to potentially identify young patients at risk of acute coronary syndrome (ACS) despite normal coronary arteries. Methods: A retrospective cross sectional study was undertaken over an 8 year period at Tawam Hospital. 576 patients aged 50 or under who underwent coronary angiography were selected for the study. Medical records were analyzed for the patient's demographics and CAD risk factor profile, including the following variables: family history of CAD, smoking status, Body Mass Index category, lipid profile, and diagnosis of hyperlipidemia, diabetes, or hypertension. Details of the coronary angiogram were also reviewed. Results: Statistically significant outcomes included a higher prevalence of diabetes, hyperlipidemia, and smoking history in patients with CAD compared to the patients with normal coronary angiogram. Diabetes was one of the strongest risk factors in CAD patients, with an odds ratio of 1.98 (p= 0.011), followed by hyperlipidemia at 1.85 (p= 0.021). Smoking history had an odds ratio of 2.93 (p <0.001). Conclusion: Risk factors were present in both groups, but significantly more in the CAD group. No particular risk factor stood out for the development of ACS in those with normal coronary arteries, other than mean BMI being slightly higher in this group. Based on our analysis, no single variable can accurately predict the risk for ACS in normal coronaries. To our knowledge, few studies have been done in the young population with angiographically normal coronary arteries to determine possible risk factors for development of ACS. Further research needs to be done to determine whether the risk factors that were common amongst both groups are coincidental, or a cause of ACS in those with normal coronary arteries.
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Affiliation(s)
- Sarah Jamil
- Internal Medicine, Tawam Hospital, Al Ain, United Arab Emirates
| | - Gohar Jamil
- Department of Cardiology, Tawam Hospital, Al Ain, United Arab Emirates.,Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Hanaa Mesameh
- Nursing, Tawam Hospital, Al Ain, United Arab Emirates
| | | | - Juma AlKaabi
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Charu Sharma
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | | | | | - Javed Yasin
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Epidemiological profile and management patterns of acute myocardial infarction in very young patients from a tertiary care center. Indian Heart J 2020; 72:32-39. [PMID: 32423558 PMCID: PMC7231868 DOI: 10.1016/j.ihj.2020.03.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2019] [Revised: 02/18/2020] [Accepted: 03/12/2020] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Cardiovascular disease is the leading cause of death in India. Previously it was thought to be a disease of the elderly but now an epidemiological transition is being seen with increasing incidence in the very young adults as well. Such patterns are not well studied in the South East Asian population. OBJECTIVE To study the epidemiological profile of very young (≤35 years) adults presenting with an acute myocardial infarction (AMI) in comparison with an older cohort. METHODOLOGY The present study included all patients presenting with AMI to the emergency or to the out-patient department of the G B Pant Institute of Postgraduate Medical Education and Research (GIPMER), New Delhi between January 2014 and October 2015. A total of 102 subjects ≤35 years with AMI comprised the study subjects (cases) and were compared with 104 subjects >35 years old with AMI (Controls). RESULTS & CONCLUSION Most of the very young AMI patients presented with an anterior wall ST segment elevation myocardial infarction, a stable hemodynamic profile, single vessel disease and better left ventricular ejection fraction as compared with controls. Most of the patients were from urban and semi-urban areas, middle and lower middle socioeconomic status and were smokers but lacked other traditional risk factors.
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Zafirovska B, Otljanska M, Petkoska D, Kedev S. RISK FACTOR DISTRIBUTION AND LONG-TERM OUTCOMES IN YOUNG PATIENTS UNDERGOING PERCUTANEOUS CORONARY INTERVENTION IN MACEDONIA. Acta Clin Croat 2019; 58:583-589. [PMID: 32595241 PMCID: PMC7314289 DOI: 10.20471/acc.2019.58.04.03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The aim was to assess coronary artery disease (CAD) risk factor distribution and long-term outcomes in young patients undergoing percutaneous coronary intervention (PCI) in Macedonia. A total of 12,361 PCI patients (from March 2011 to December 2017) were included in the study. Group 1 included 309 young patients aged ≤40 as the main study group, comparing them to 12,052 older PCI patients (group 2) during the study period. We compared CAD risk factor distribution, clinical and procedure characteristics. Additionally, angiographic data, long-term major adverse cardiac and cerebrovascular events (MACCE) and mortality were analyzed in group 1 patients. Median age was 36±4 years in group 1 and 62±11 years in group 2. Male patients predominated in both groups (88% vs.73%). Positive family history for CAD, smoking and obesity was much more common in the young group (p<0.0001). ST segment elevation myocardial infarction (STEMI) primary PCI was also more frequent with 48% of PCI in the young group (p<0.0001). Multivessel CAD and chronic total occlusion interventions were more common in the older group (51% and 28%, respectively; p<0.0001). Procedure duration (31±0.4 vs. 35±22 min) and fluoroscopy time (9±4 vs. 9±12 min) were similar in both groups. There was no difference in access site bleeding (4.8% vs. 4.3%). During the 3.5-year median follow up, MACCE was present in 1.9% of young patients. In conclusion, positive family history for CAD, obesity and smoking were the most common risk factors in the young PCI population. Young PCI patients usually had single vessel CAD with STEMI being more frequent as the cause for primary PCI. Long-term annual survival exceeded 99% in these patients with excellent prognosis after PCI.
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Affiliation(s)
| | - Magdalena Otljanska
- University Clinic of Cardiology, Faculty of Medicine, University of St Cyril & Methodius, Skopje, Macedonia
| | - Danica Petkoska
- University Clinic of Cardiology, Faculty of Medicine, University of St Cyril & Methodius, Skopje, Macedonia
| | - Sasko Kedev
- University Clinic of Cardiology, Faculty of Medicine, University of St Cyril & Methodius, Skopje, Macedonia
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Bugiardini R, Manfrini O, Cenko E. Female sex as a biological variable: A review on younger patients with acute coronary syndrome. Trends Cardiovasc Med 2019; 29:50-55. [DOI: 10.1016/j.tcm.2018.06.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2018] [Revised: 06/06/2018] [Accepted: 06/07/2018] [Indexed: 01/12/2023]
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Ricci B, Cenko E, Vasiljevic Z, Stankovic G, Kedev S, Kalpak O, Vavlukis M, Zdravkovic M, Hinic S, Milicic D, Manfrini O, Badimon L, Bugiardini R. Acute Coronary Syndrome: The Risk to Young Women. J Am Heart Assoc 2017; 6:JAHA.117.007519. [PMID: 29273636 PMCID: PMC5779054 DOI: 10.1161/jaha.117.007519] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Background Although 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 Results Between 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 Registration URL: http://clinicaltrials.gov/. Unique identifier: NCT01218776.
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Affiliation(s)
- Beatrice Ricci
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Edina Cenko
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Zorana Vasiljevic
- Clinical Center of Serbia, Medical Faculty, University of Belgrade, Serbia
| | - Goran Stankovic
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Sasko Kedev
- University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Oliver Kalpak
- University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Marija Vavlukis
- University Clinic of Cardiology, Medical Faculty, University "Ss. Cyril and Methodius", Skopje, Macedonia
| | - Marija Zdravkovic
- University Clinical Hospital Center Bezanijska Kosa, Faculty of Medicine, University of Belgrade, Serbia
| | - Sasa Hinic
- University Clinical Hospital Center Bezanijska Kosa, Faculty of Medicine, University of Belgrade, Serbia
| | - Davor Milicic
- Department for Cardiovascular Diseases, University Hospital Center Zagreb, University of Zagreb, Croatia
| | - Olivia Manfrini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
| | - Lina Badimon
- Cardiovascular Research Institute (ICCC), CiberCV-Institute Carlos III, IIB-Sant Pau, Hospital de la Santa Creu i Sant Pau, Autonomous University of Barcelona, Spain
| | - Raffaele Bugiardini
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy
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Saraiva J, Antunes PE, Antunes MJ. Coronary artery bypass surgery in young adults: excellent perioperative results and long-term survival. Interact Cardiovasc Thorac Surg 2017; 24:691-695. [PMID: 28453797 DOI: 10.1093/icvts/ivw407] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2016] [Accepted: 11/03/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To analyse perioperative results, long-term survival and freedom from complications after coronary artery bypass grafting (CABG) in young adults. METHODS A total of 163 patients, 40 years old or younger, had isolated CABG from January 1989 to December 2010. Pre- and perioperative demographic and clinical data were retrieved from a prospectively organised database. Follow-up data were obtained by letter or telephone interviews. The mean age of the patients was 37.6 ± 2.9 years and 146 were men (90%). Fifty-three patients (32.5%) had angina class III/IV; 106 (65.0%), previous myocardial infarction; and 23 (14.1%), impaired left ventricular function (ejection fraction <40%). Indication for surgery was 3-vessel disease in 101 cases (62.0%), 2-vessel disease in 30 (18.4%) and single-vessel disease in 32 (19.6%). The left main stem was affected in 16 patients (9.8%). The mean EuroSCORE II was 0.92 ± 0.71. A total of 417 grafts were constructed (mean 2.6 grafts/patient), 247 of which (59.2%) were arterial. RESULTS There were no in-hospital deaths. The mean hospital stay was 7.1 ± 4.0 days. Four patients (2.5%) were lost to follow-up, which extended from 3 to 25 years (mean 15.1 ± 5.5 years). There were 22 late deaths, 72.7% of cardiac or unknown origin. The 5-, 10- and 20-year survival rates were 98.7 ± 10.9, 95.2 ± 1.8 and 79.4 ± 4.4%, respectively. Twenty-six patients (18.1%) had non-fatal cardiac adverse complications (myocardial infarct, percutaneous re-revascularization or class III/IV angina), for 5-, 10- and 20-year freedom from complications of 97.9 ± 1.2, 91.9 ± 2.5 and 65.7 ± 7.1%, respectively. Twenty-two patients (17.5%) needed re-revascularization, for 5-, 10- and 20-year freedom from re-revascularization of 97.6 ± 1.4, 91.9 ± 2.6 and 69.5 ± 6.7%, respectively. CONCLUSIONS Despite the aggressive nature of coronary artery disease in young patients, perioperative death and morbidity rates are low, with good long-term survival and low rates of re-revascularization.
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Affiliation(s)
- Joana Saraiva
- Centre of Cardiothoracic Surgery, Coimbra, University Hospital and Faculty of Medicine, Coimbra, Portugal
| | - Pedro E Antunes
- Centre of Cardiothoracic Surgery, Coimbra, University Hospital and Faculty of Medicine, Coimbra, Portugal
| | - Manuel J Antunes
- Centre of Cardiothoracic Surgery, Coimbra, University Hospital and Faculty of Medicine, Coimbra, Portugal
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Trzeciak P, Wożakowska-Kapłon B, Niedziela J, Gierlotka M, Hawranek M, Lekston A, Wasilewski J, Poloński L, Gąsior M. Comparison of Inhospital and 12- and 36-Month Outcomes After Acute Coronary Syndrome in Men Versus Women <40 Years (from the PL-ACS Registry). Am J Cardiol 2016; 118:1300-1305. [PMID: 27616341 DOI: 10.1016/j.amjcard.2016.07.067] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Revised: 07/28/2016] [Accepted: 07/28/2016] [Indexed: 11/19/2022]
Abstract
The study was aimed to compare the characteristics and inhospital and 12- and 36-month outcomes of men and women <40 years with acute coronary syndrome (ACS). The analysis involved 932 patients <40 years with ACS in the Silesia region enrolled into the ongoing, prospective Polish Registry of Acute Coronary Syndromes from January 2006 to December 2014. The composite end point involved death, recurrence of ACS, a need for percutaneous coronary intervention, and coronary artery bypass graft surgery within 12 and 36 months after ACS. Compared with men, women <40 years were less frequently smokers (66.1% vs 55.4%, p = 0008), had older average age (35.6 ± 4.2 vs 34.7 ± 4.4, p = 0.002), more often had unstable angina at admission (29.1% vs 19.3%, p <0.001), and less frequently had ST-elevation myocardial infarction: 41.3% versus 51.3%, p = 0.02, at admission. There was no significant difference in the mortality (4.8% vs 3.1%, p = 0.29) and the composite end point (21.6% vs 16.0%, p = 0.14) within 12 months after ACS. Compared with men, women had a higher incidence of the composite end point (28.4% vs 20.1%, p = 0.04) and indicated a tendency of a higher mortality within the 36-month follow-up period (9.2% vs 5.0%, p = 0.055). Female gender turned out to be an independent risk factor of death in the multivariate analysis (hazard ratio 2.76, 95% confidence interval 1.21 to 6.31, p <0.016). In conclusion, women had a higher incidence of the composite end point and showed a tendency toward a higher mortality than the men within the 36-month follow-up period.
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Affiliation(s)
- Przemysław Trzeciak
- Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland.
| | - Beata Wożakowska-Kapłon
- First Clinical Department of Cardiology, Świętokrzyskie Centre of Cardiology, Kielce, Poland; University of Health Sciences, Jan Kochanowski University, Kielce, Poland
| | - Jacek Niedziela
- Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Marek Gierlotka
- Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Michał Hawranek
- Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Andrzej Lekston
- Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Jarosław Wasilewski
- Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Lech Poloński
- Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Mariusz Gąsior
- Third Department of Cardiology, SMDZ in Zabrze, Medical University of Silesia, Katowice, Poland
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Alkhawam H, Sogomonian R, El-Hunjul M, Kabach M, Syed U, Vyas N, Ahmad S, Vittorio TJ. Risk factors for coronary artery disease and acute coronary syndrome in patients ≤40 years old. Future Cardiol 2016; 12:545-52. [PMID: 27492147 DOI: 10.2217/fca-2016-0011] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE In this study, we assessed the risk factor profile in premature coronary artery disease (CAD) and acute coronary syndrome for adults ≤40 years old. METHODS A retrospective chart analysis of 397 patients ≤40 years old admitted from 2005 to 2014 for chest pain and who underwent coronary arteriography. RESULTS Of 397 patients that had undergone coronary arteriography, 54% had CAD while 46% had normal coronary arteries. When compared with patients with normal coronary arteries, patients with CAD were more likely to smoke tobacco, have dyslipidemia, be diabetic, have BMI >30 kg/m(2), have a family history of premature CAD and be male in gender. CONCLUSION Healthcare intervention in the general population through screening, counseling and education regarding the risk factors is warranted to reduce premature CAD.
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Affiliation(s)
- Hassan Alkhawam
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Robert Sogomonian
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Mohammed El-Hunjul
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Mohamad Kabach
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Umer Syed
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Neil Vyas
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Sumair Ahmad
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
| | - Timothy J Vittorio
- Department of Medicine, Icahn School of Medicine at Mount Sinai (Elmhurst), NY, USA.,Department of Neurology, Lehigh Valley Health Network, Allentown, PA, USA.,Department of Medicine, University of Miami Miller School of Medicine, Palm Beach Regional Campus, FL, USA.,St. Francis Hospital - Heart Center, Roslyn, NY, USA
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Comparison of Long-Term Mortality of Patients Aged ≤40 Versus >40 Years With Acute Myocardial Infarction. Am J Cardiol 2016; 118:319-25. [PMID: 27328956 DOI: 10.1016/j.amjcard.2016.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Revised: 05/04/2016] [Accepted: 05/04/2016] [Indexed: 11/24/2022]
Abstract
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.
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AMI in very young (aged ≤35years) Bangladeshi patients: Risk factors & coronary angiographic profile. ACTA ACUST UNITED AC 2016. [DOI: 10.1016/j.ctrsc.2015.11.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Yunyun W, Tong L, Yingwu L, Bojiang L, Yu W, Xiaomin H, Xin L, Wenjin P, Li J. Analysis of risk factors of ST-segment elevation myocardial infarction in young patients. BMC Cardiovasc Disord 2014; 14:179. [PMID: 25487289 PMCID: PMC4271480 DOI: 10.1186/1471-2261-14-179] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2014] [Accepted: 12/01/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Acute myocardial infarction (AMI) is often present in old populations and rare in young people. Its incidence significantly increased recent years. The mechanism and disease course of AMI in young people are probably different from that in old population. The aim of this study was to analyze clinical risk factors of STEMI in young patients. METHODS Data was collected from consecutive patients ≤ 44 years of age (young; n = 86) and 60-74 years of age (old; n = 65) diagnosed with STEMI, and 79 young age-matched patients without coronary artery disease (CAD), hospitalized between January 2009 and June 2013. RESULTS The young STEMI group had a significantly higher proportion of males (88.37 vs. 53.16%; P < 0.01), smokers (82.56 vs. 49.37%; P < 0.01) and patients with a family history of early CAD (54.65 vs. 32.91%; P < 0.05) than age-matched controls. Young STEMI patients also had significantly higher levels of fasting blood sugar (6.39 vs. 5.25 mmol/L; P < 0.001), glycated hemoglobin (HbA1c) (6.26 vs. 5.45%; P < 0.05), total cholesterol (5.14 vs. 4.65 mmol/L, P < 0.05), and fibrinogen (Fib) (3.39 vs. 2.87; P < 0.01). Compared with the old STEMI group, young STEMI patients had significantly higher proportions of males (88.37 vs. 63.08%; P < 0.01) smokers (82.56 vs. 41.54%; P < 0.01), and those with a family history of early CAD (54.65 vs. 18.46%; P < 0.01). Young STEMI patients also lower Fib (3.39 vs. 3.88 g/L; P < 0.01), less frequent occurrence of angina pectoris before STEMI (13.95 vs. 29.23%; P < 0.05) compared with the old STEMI group. Logistic regression analysis indicated that male sex (OR = 5.891), smoking (OR = 3.500), family history of early CAD (OR = 3.194), Fib (OR = 2.414) and HbA1c (OR = 1.515) are associated with STEMI in young patients. CONCLUSION In addition to previously recognized risk factors (male sex, smoking and family history of early CAD), Fib and HbA1c are associated with STEMI in individuals ≤ 44 years of age without antecedent angina pectoris.
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Affiliation(s)
- Wang Yunyun
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Li Tong
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Liu Yingwu
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Liu Bojiang
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Wang Yu
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Hu Xiaomin
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Li Xin
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - Peng Wenjin
- />Cardiac Center, Third Central Hospital of Tian Jin, Tian Jin, 300170 China
| | - JinFang Li
- />Essen Medical Associates, P.C.2015 Grand concourse, Bronx, NY 10453 USA
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In-hospital and 12-month outcomes after acute coronary syndrome treatment in patients aged<40 years of age (from the Polish Registry of Acute Coronary Syndromes). Am J Cardiol 2014; 114:175-80. [PMID: 24878122 DOI: 10.1016/j.amjcard.2014.04.024] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2014] [Revised: 04/17/2014] [Accepted: 04/17/2014] [Indexed: 12/12/2022]
Abstract
We aimed to compare the characteristics and in-hospital and 12-month outcomes in patients aged>40 and <40 years with acute coronary syndrome. The analysis involved 789 patients aged<40 years and 63,057 patients aged≥40 years enrolled in the ongoing Polish Registry of Acute Coronary Syndromes from October 2003 to December 2009. Patients aged<40 years with acute coronary syndrome differed from older patients in their clinical characteristics, treatment, and clinical outcome. The older patients more frequently had pulmonary edema (2.9% vs 0.4%, p<0.0001) and cardiogenic shock (4.7% vs 2.8%, p=0.011) on admission. For the younger patients, coronary angiography and percutaneous coronary intervention were performed more often (71.5% vs 60.5%, p<0.0001 and 51.5% vs 47.7%, p=0.04, respectively). The younger patients had a lower mortality rate than the older patients during hospitalization (1.5% vs 5.2%, p<0.0001) and during 12-month follow-up period (4.1% vs 13.4%, p<0.0001). Multivariate analysis revealed that age<40 years was one of the strongest factors associated with lower mortality during the 12 months after discharge (hazard ratio 0.42, 95% confidence interval 0.29 to 0.62, p<0.0001). In conclusion, younger patients had more favorable in-hospital and 1-year outcomes than older patients, and the age<40 years was revealed to be one of the strongest factors associated with lower mortality during the 1-year follow-up.
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Jinnouchi H, Sakakura K, Wada H, Kubo N, Sugawara Y, Funayama H, Ako J, Momomura SI. Clinical features of myocardial infarction in young Japanese patients. Int Heart J 2013; 54:123-8. [PMID: 23774233 DOI: 10.1536/ihj.54.123] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Clinical features and outcomes of acute myocardial infarction (AMI) in the young have been poorly investigated. The aim of this study was to investigate the clinical features and hospital outcomes of AMI in young Japanese. We conducted a case-control study. A total of 53 consecutive AMI patients whose age was ≤ 45 years old were assigned to the young group and 106 AMI patients whose age was > 45 years old were assigned to the non-young group. We compared the clinical features and hospital outcomes between the two groups. Compared with the non-young group, the young group was associated with male sex, hyperlipidemia, current smoking, being overweight, single vessel disease, and Killip class I on admission. There were no differences in the length of hospital stay or major adverse cardiac events between the groups. However, mortality and ventricular rupture were slightly lower in the young. In conclusion, young AMI patients had clinical characteristics different to those of the non-young patients. Compared to non-young patients, modifiable risk factors such as smoking, hyperlipidemia, and being overweight were associated with young AMI patients.
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Affiliation(s)
- Hiroyuki Jinnouchi
- Department of Cardiovascular Medicine, Saitama Medical Center, Jichi Medical University, Japan
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16
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Sakowicz A, Fendler W, Lelonek M, Sakowicz B, Pietrucha T. Genetic polymorphisms and the risk of myocardial infarction in patients under 45 years of age. Biochem Genet 2012; 51:230-42. [PMID: 23274712 PMCID: PMC3599159 DOI: 10.1007/s10528-012-9558-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2012] [Accepted: 11/26/2012] [Indexed: 11/17/2022]
Abstract
This study investigates the potential role of 17 chosen polymorphisms in 15 candidate genes and the risk of myocardial infarction in patients under 45 years of age. The study consists of 271 patients with myocardial infarction and 141 controls. The analysis of genetic polymorphisms was performed using the PCR–RFLP method. Of the chosen polymorphisms, two (Leu125Val PECAM1 and A1/A2 FVII) are related to myocardial infarction and two (C677T MTHFR and 5A/6A MMP3) to advanced stenosis in arterial vessels (> 75%). We also found that the frequency of some combinations among the analyzed genes and environmental factors varied between the patient and control groups.
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Affiliation(s)
- Agata Sakowicz
- Department of Medical Biotechnology, Medical University of Lodz, Zeligowskiego 7/9, 90-725, Lodz, Poland.
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Chen SM, Tsai TH, Hang CL, Yip HK, Fang CY, Wu CJ, Guo GBF. Endothelial dysfunction in young patients with acute ST-elevation myocardial infarction. Heart Vessels 2010; 26:2-9. [DOI: 10.1007/s00380-010-0017-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2009] [Accepted: 01/12/2010] [Indexed: 11/24/2022]
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L J, N B, O R, J-Y W, R LB, J L, J-P M. [Acute myocardial infarction in young smokers treated by coronary angioplasty. In-hospital prognosis and long-term outcome in a consecutive series of 93 patients]. Ann Cardiol Angeiol (Paris) 2010; 59:119-24. [PMID: 20511119 DOI: 10.1016/j.ancard.2010.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2009] [Accepted: 04/06/2010] [Indexed: 11/16/2022]
Abstract
AIMS OF THE STUDY The study evaluated in-hospital and long-term outcome of patients less than 50 years old with myocardial infarction within 12 hours after symptom onset treated by coronary angioplasty. PATIENTS AND METHOD This is a retrospective study with survival analysis by Kaplan-Meier method in patients included from December 2003 to February 2008. RESULTS We included 93 patients aged 42,8+/-5,2 years old with smoking estimated at 27,7+/-12,7 pack-years. Thirty-one patients (33,3%) were dyslipidemic and 36 patients had family history of coronary artery disease. Thirty patients (32,3%) had an anterior myocardial infarction and four patients (4.4%) had Killip greater than 2. Coronary angioplasty was performed within 4.5+/-3.0 hours after symptom onset with TIMI 3 final flow in the culprit vessel in 96.8%. One patient died from cardiogenic shock. With a follow-up of 85 patients during 20.0+/-15.6 months, the survival without death was 98.2% and survival without major cardiac complication was 87.9% at 24 months. Seventy-two patients (85.7%) were taking a betablocker, 81 patients (96.4%) aspirin, 75 patients (89.3%) a statin and 64 patients (76.2%) an angiotensin-converting inhibitor. Only 50 patients (58.8%) were nonsmokers. CONCLUSION Thus, young smokers with acute MI treated by coronary angioplasty have a good prognosis during in-hospital stay and long-term outcome. Secondary medical treatment prevention is well followed but there is a low rate of smoking cessation.
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Affiliation(s)
- Jacquemin L
- Service de cardiologie, centre hospitalier Emile-Muller, 20, rue du Docteur Laennec, Mulhouse, France.
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Acute myocardial infarction in a young woman. COR ET VASA 2009. [DOI: 10.33678/cor.2009.197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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20
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Rasmussen LD, Gerstoft J, Kronborg G, Larsen CS, Pedersen G, Obel N. Mortality after myocardial infarction in HIV-infected patients who have initiated HAART. AIDS 2007; 21:873-5. [PMID: 17415045 DOI: 10.1097/qad.0b013e3280b07dc6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
We identified all Danish HIV patients registered with myocardial infarction (MI) when on HAART (44 patients) and compared their mortality with that of matched patients with MI and no HIV and patients with HIV and no MI. Mortality in HIV-infected MI patients was not significantly different to that of MI only patients in the first 90 days post-MI and thereafter was not significantly different to that of HIV patients without MI.
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Affiliation(s)
- Line D Rasmussen
- Department of Infectious Diseases, Odense University Hospital, University of Southern Denmark, Odense, Denmark
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Boccara F, Ederhy S, Janower S, Benyounes N, Odi G, Cohen A. Clinical characteristics and mid-term prognosis of acute coronary syndrome in HIV-infected patients on antiretroviral therapy. HIV Med 2006; 6:240-4. [PMID: 16011528 DOI: 10.1111/j.1468-1293.2005.00283.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Acute coronary syndromes (ACSs) and coronary artery disease are emerging complications in HIV-infected patients on highly active antiretroviral treatment. The aim of this study was to determine the mid-term prognosis of ACS in HIV-infected patients. METHODS We evaluated the clinical characteristics and follow-up profile [38+/-15 months; mean+/-standard deviation (SD)] of ACS in 20 HIV-infected patients (mean +/-SD: age 44+/-8 years; range 35-65 years). All had coronary angiograms performed mean time 3+/-48 h after the onset of symptoms. RESULTS Eighteen patients were on antiretroviral therapy, of whom 13 patients were on regimens including protease inhibitors (mean duration+/-SD: 19+/-13 months). Fifteen patients had a first episode of ST segment elevation ACS and five had non-ST segment elevation ACS. Tobacco consumption (80%) and hypercholesterolaemia (50%) were the most frequent cardiovascular risk factors. During initial hospitalization, four patients were treated with thrombolysis, two had primary coronary angioplasty and seven had secondary coronary angioplasty. At follow up, 10 patients (50%) had had 18 cardiovascular events: one cardiovascular death, seven episodes of recurrent myocardial ischaemia in four patients, three pulmonary oedemas in two patients, and seven revascularization procedures in five patients. CONCLUSIONS This preliminary report highlights the risk of ACS and related complications in HIV-infected patients and raises questions regarding the implications of antiretroviral treatment.
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Affiliation(s)
- F Boccara
- Service de Cardiologie, Saint-Antoine University and Medical School, Assistance Publique-Hôpitaux de Paris and Université Pierre et Marie Curie (Paris VI), Paris, France
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Shiraishi J, Kohno Y, Yamaguchi S, Arihara M, Hadase M, Hyogo M, Yagi T, Shima T, Sawada T, Tatsumi T, Azuma A, Matsubara H. Medium-Term Prognosis of Young Japanese Adults Having Acute Myocardial Infarction. Circ J 2006; 70:518-24. [PMID: 16636483 DOI: 10.1253/circj.70.518] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Data on the medium- and long-term prognosis of young Japanese patients with acute myocardial infarction (AMI) are still lacking. METHODS AND RESULTS In the present study, 1,458 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and December 2003. Of these, clinical characteristics and medium-term prognosis were retrospectively compared in 21 young patients < 40 years (young group), and 190 non-young patients 60-70 years old (non-young group) who could be followed after hospital discharge. The young group was all male and had higher prevalence of current smoking and greater body mass index, but previous myocardial infarction (MI) and hypertension were more prevalent in the non-young group. The young group had a higher prevalence of single-vessel disease and a lesser incidence of left circumflex coronary artery as the culprit lesion. The acquisition rates of Thrombolysis In Myocardial Infarction 3 flow after primary percutaneous coronary intervention did not differ between the 2 groups, but the data of maximal creatine kinase was significantly higher in the young group. During the follow-up period (average 2.42 years for young, 2.37 years for non-young), survival and event-free survival rates and incidence of major adverse cardiac events (MACE) did not differ between the 2 groups. The predictor of MACE during follow-up period was the presence of multivessel disease in the young group, whereas the presence of multivessel disease, history of previous MI and longer hospitalization were the predictors of MACE in the non-young group. CONCLUSIONS These results suggest that the medium-term prognosis in young AMI patients is comparable to that of non-young AMI patients in Japan.
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Affiliation(s)
- Jun Shiraishi
- Department of Cardiology, Kyoto First Red Cross Hospital, Kyoto, Japan.
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Shiraishi J, Kohno Y, Yamaguchi S, Arihara M, Hadase M, Hyogo M, Yagi T, Shima T, Sawada T, Tatsumi T, Azuma A, Matsubara H. Acute Myocardial Infarction in Young Japanese Adults Clinical Manifestations and In-Hospital Outcome. Circ J 2005; 69:1454-8. [PMID: 16308491 DOI: 10.1253/circj.69.1454] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND The prevalence and clinical manifestations of acute myocardial infarction (AMI) in young patients in Japan have not been fully investigated. METHODS AND RESULTS In the present study, 1651 AMI patients were enrolled in the AMI-Kyoto Multi-Center Risk Study between January 2000 and June 2004. Of these, the clinical background, risk factors, angiographic findings, acute results of primary percutaneous coronary intervention (PCI) and in-hospital outcomes for 27 young patients <40 (young group), and 338 non-young patients 60<or=, <70 years old (non-young group) were retrospectively compared. The young AMI patients were all male. Current smoking, hypercholesterolemia and family history were the most common risk factors in young patients, while hypertension and diabetes mellitus were more prevalent in non-young patients. Young patients had a higher prevalence of single-vessel disease and a lesser incidence of left circumflex coronary artery as a culprit lesion. The young group had high acquisition rates of Thrombolysis In Myocardial Infarction 3 flow just after primary PCI (95.8%) and no in-hospital deaths, which was not significantly different from the non-young group. CONCLUSIONS These results suggest that young AMI patients have different clinical characteristics from those in non-young AMI patients, and acute results of primary PCI and in-hospital prognosis in young AMI patients are comparable to those in non-young AMI patients in Japan.
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Affiliation(s)
- Jun Shiraishi
- Department of Cardiology, Kyoto First Red Cross Hospital, and Department of Cardiology and Vascular Regenerative Medicine, Kyoto Prefectural University School of Medicine, Japan.
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Abstract
OBJECTIVE To define the risk factors and clinical presentations of young patients (<or=45 years) who present to King Fahd Hospital of the University (KFHU) with an acute myocardial infarction (MI). METHODS AND RESULTS A retrospective study was conducted over a 3-year period from January 1999 to December 2001. Sixty-five consecutive cases of acute MI in young patients were admitted to KFHU and were reviewed. The mean age was 40 years (range 29-45), 96.9% were males, 66.2% were from the Indian subcontinent, 23.1% were Saudi nationals and 10.8% were of other nationality. The major risk factor was tobacco use (76.9%), followed by low HDL (52.8%), high LDL (33.8%), diabetes (30.8%), hypertension (18.5%), family history of IHD (15.4%) and hypertriglyceridemia (7.7%). The most common anatomical location of the MI was the anterior wall and 92.3% of the cases were MIs with ST segment elevation. The hospital course was complicated by the development of CHF (4.6%), cardiogenic shock (4.6%), angina post-MI (3.1%), and reinfarction (3.1%). Finally, the hospital mortality rate was 9.2%. CONCLUSIONS The study focuses our attention on the rising incidence of acute MI in young individuals. Smoking was the major risk factor followed by low HDL, high LDL and diabetes. These observations are important for primary prevention of such diseases in Saudi Arabia.
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Affiliation(s)
- Akram H Al-Khadra
- King Fahd Hospital of the University, King Faisal University, Dammam, Saudi Arabia.
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Awad-Elkarim AA, Bagger JP, Albers CJ, Skinner JS, Adams PC, Hall RJC. A prospective study of long term prognosis in young myocardial infarction survivors: the prognostic value of angiography and exercise testing. Heart 2003; 89:843-7. [PMID: 12860853 PMCID: PMC1767794 DOI: 10.1136/heart.89.8.843] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To define the ability of early exercise testing and coronary angiography to predict prognosis in young survivors of myocardial infarction (MI). METHODS 255 consecutive patients (210 men) aged 55 years or less (mean 48 years) admitted to hospital (1981-85) were eligible. Of these, 150 patients (130 men) who were able to exercise early after MI and underwent coronary angiography within six months constituted the study group and were followed up for up to 15 years. Survival data up to 18 years was obtained for the whole cohort. RESULTS Survival at a median of 16 years was 52% for the whole cohort, 62% for the study group, and 48% for the excluded group. From nine years onwards survival deteriorated significantly in the study group compared with an age matched background population. Fifteen years after MI, 121 patients (81%) in the study group had had at least one event (death, MI, revascularisation, cardiac readmission, stroke) leaving 29 (19%) event-free. The number of diseased vessels was the major determinant of time to first event (p = 0.001) and event-free survival (p = 0.04). Exercise duration was also important in the prediction of time to first event (p = 0.003). Death was influenced by a history of prior MI. CONCLUSION The favourable initial survival was followed by significant deterioration after nine years. This late attrition is an important treatment target. Furthermore, this study supports risk stratification early after MI combining angiography with non-invasive tools.
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Affiliation(s)
- A A Awad-Elkarim
- Cardiothoracic Directorate, Faculty of Medicine, Imperial College School of Science, Technology and Medicine, Hammersmith Hospital, London, UK.
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