Myocardial infarction the young – our results and experience

Česká verze

Authors: I. Riečanský ¹; J. Pacák ²; J. Péč ²; J. Melicherčík ³
Authors place of work: Katedra kardiológie a angiológie Lekárskej fakulty SZU, Kardiologická klinika Národného ústavu srdcových a cievnych chorôb Bratislava, Slovenská republika, prednosta prof. MUDr. Róbert Hatala, CSc. ¹; Oddelenie intervenčnej kardiológie Kardiologickej kliniky Národného ústavu srdcových a cievnych chorôb Bratislava, Slovenská republika, vedúci lekár prim. MUDr. Viliam Fridrich, PhD. ²; Mediclin Herzzentrum, Klinik Fűr Innere Medizin und Kardiologie, Lahr/Baden, Deutsche Republik, Oberartzt doc. MUDr. Ján Melicherčík, PhD. ³
Published in the journal: Vnitř Lék 2012; 58(7 a 8): 75-82
Category: 80. narozeniny prof. MUDr. Miroslava Mydlíka, DrSc.

Summary

Aims:
Coronary artery disease in young adults is important task of contemporary cardiology. Presented our results experience and opinion were obtained by our long term investigation of myocardial infarction in young patients under 40 years.

Methods:
Two sets of patients were examined – 78 patients (74 men, 4 women) hospitalised in pretrombolytic era in prospective 8 years follow up (1984–1992) and 39 patients (35 men, 4 women) admitted during period 2000–2010 analysed retrospective.

Results:
Myocardial infarction in young age belongs roughly to two different groups with considerable overlap in pathogenetic mechanisms: 1. angiographycally normal coronary arteries or unilocular nonsignificant atherosclerotic stenosis (less 50%) in 25–30% with thrombotic occlusion of one infarct related artery probably with substantial vasospastic component. Patients were younger (average 31.7 ± 3.7 years), dominant risk factors smoking, hyperlipidemia, excesive physical and emotional stress. Disease course and prognosis are favourable. 2. premature accelerated atherosclerosis with significant (more 50%) in 70–75 % offen multivessel affection. Pts were significantly older (average 35.8 ± 2.6 years; < 0.001) bad risk factors profile, worse clinical course and poore long-term prognosis.

Conclusions:
Study of myocardial infarction in young adults indicates: great role of risk factors, mainly smoking, hyperlipidemia, family history and type A behaviour, hostility with participation of low education level and social inequality (unemployment). Noticeable are hypercoagulable states and trauma. Dominancy of men (90–95%). Prognosis depends on age, extend of coronary atherosclerosis and residual cardiac function. Disease picture has not been changed during last 30 years. Agressive control over risk factors is unavoidable. Current requirement is to evalute impact of modern treatment strategy on long-term survival.

Key words:
coronary artery disease – myocardial infarction at young age

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