Myocardial infarction the young – our results and experience
Authors:
I. Riečanský 1; J. Pacák 2; J. Péč 2; J. Melicherčík 3
Authors‘ workplace:
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:
Vnitř Lék 2012; 58(7 a 8): 75-82
Category:
80th Birthday MUDr. Miroslav Mydlík, DrSc.
Overview
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
Sources
1. Haviar V. Infarkty myokardu v mladom veku. Bratisl Lek Listy 1946; 26: 1–11.
2. Roskamm H (ed.). Myocardial infarction at young age. Berlin-Heidelberg-New York: Springer-Verlag 1982: 230 s.
3. Riečanský I, Melicherčík J, Kasper J et al. Myocardial infarction at young age. In: Nichaman MZ, Epstein FH (eds). CVD Epidem Newsletter Council on Epidemiology. Am Heart Assoc 1987; 42: 107–109.
4. Riečanský I, Egnerová A. Kardiovaskulárny program na Slovensku v rokoch 1978–1989. Bratisl Lek Listy 1991; 92: 203–218.
5. Dufek V. Infarkty myokardu u mladých lidí. Praha: Státní zdrav. nakladatelství 1957.
6. Šimon J, Sova J, Švojgrová M et al. Retrospective study of men who had under gone myocardial infarction at the age of 40 years or younger. Cor Vasa 1974; 16: 91–102.
7. Vojáček J, Fabián J, Belán A. Infarkt myokardu u mužú do 40 let. Koronarografický nález a dlouhodobá prognoza. Čas Lék Čes 1986; 125: 111–114.
8. Riečanský I, Melicherčík J, Kasper J et al. Myocardial infarction at young age. Czechoslov Med 1988; 11: 123–130.
9. Vojtíšek P, Kos J. Čerstvý srdeční infarkt u osob mladších 50 let. Prakt Lék 1990; 70: 51–53.
10. Toman O, Poloczek M, Pařenica J et al. Ischemická choroba srdeční s predčasnou manifestací u mladých pacientú. Vnitř Lék 2008; 54: 810–816.
11. Zimmerman FN, Cameron A, Fischer LD. Myocardial infarction in young adults: Angiographic characterization, risk factors and prognosis (Coronary artery surgery study registry). J Am Coll Cardiol 1995; 26: 654–661.
12. Choudhury L, Marsh JD. Myocardial infarction in young patients. Am J Med 1999; 107: 254–261.
13. Doughty M, Mehta R, Bruckman D et al. Acute myocardial infarction in the young – The University of Michigan experience. Am Heart J 2002; 143: 56–62.
14. Hoit BD, Gilpin EA, Henning H et al. Myocardial infarction in young patients: an analysis by age subsets. Circulation 1986; 74: 712–721.
15. Melicherčík J, Riečanský I, Kasper J et al. Myocardial infarction at young age. Long-term follow-up study. Eur Heart J 1992; 13: 280.
16. Bátorová A, Fillová A, Hrubišková K et al. Zmeny hemostázy pri srdcocievnych ochoreniach. Vnitř Lék 1986; 32: 745–753.
17. Amman P, Marschall S, Kraus M et al. Characteristics and prognosis of myocardial infarction in patients with normal coronary arteries. Chest 2000; 117: 333–338.
18. Osula S, Bell GM, Horning RS. Acute myocardial infarction in young adults: causes and management. Postgrad Med J 2002; 78: 27–30.
19. Egred M, Viswanathan G, Davis GK. Myocardial infarction in young adults. Postgrad Med J 2005; 81: 741–745.
20. Imazio M, Bobbio M, Bergerone S et al. Clinical and epidemiological characteristics of juvenile myocardial infarction in Italy: the GISSI experience. G Ital Cardiol 1998; 28: 505–512.
21. Cole JH, Miller JI, Sperling LS et al. Long--term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol 2003; 41: 521–528.
22. Anderson RE, Pfeffer MA, Thune JJ et al. High-risk myocardial infarction in the young: the VALsartan in acute myocardial iNfarcTion (VALIANT) trial. Am Heart J 2008; 155: 706–711.
23. Pineda J, Marin F, Marco P et al. The prognostic value of biomarkers after a premature myocardial infarction. In J Cardiol 2010; 143: 249–254.
24. Chua SK, Hung HF, Shyu KG et al. Acute ST-elevation myocardial infarction in young patients: 115 years of experience in a single center. Clin Cardiol 2010; 33: 140–148.
25. Oliveira A, Barros H, Maciel MJ et al. Tobacco smoking and acute myocardial infarction in young adults: A population- based case-control study. Preventive Medicine 2007; 44: 311–316.
26. Rallidis LS, Lekakis J, Panagiotakos D et al. Long-term prognostic factors of young patients (≤ 35 years) having acute myocardial infarction: the detrimental role of continuation of smoking. Eur J Cardiovasc Prev Rehabil 2008; 15: 567–571.
27. Barbash GI, White HD, Modan M et al. Acute myocardial infarction in the young – the role of smoking. Eur Heart J 1995; 16: 313–316.
28. McManus DD, Piacentine SM, Lessard D et al. Thirty-Year (1975 to 2005) Trends in the incidence rates, clinical features, treatment practices, and short-term outcomes of patients < 55 years of age hospitalized with an initial acute myocardial infarction. Am J Cardiol 2011; 108: 477–482.
29. Rallidis LS, Pitsavos Ch, Panagiotakos DB et al. Non-high density lipoprotein cholesterol is the best discriminator of myocardial infarction in young individuals. Atherosclerosis 2005; 179: 305–309.
30. Wiesbauer F, Blessberger H, Azar D et al. Familial-combined hyperlipidaemia in very young myocardial infarction survivors (≤ 40 years of age). Eur Heart J 2009; 30: 1073–1079.
31. Goliasch G, Oravec S, Blessberger H et al. Relative importance of different lipid risk factors for the development of myocardial infarction at a very young age (≤ 40 years of age). Eur J Clin Invest 2012; 42: 631–636.
32. Panagiotakos DB, Loukianos SR, Pitsavos C et al. Cigarette smoking and myocardial infarction in young men and women: a case-control study. Int J Cardiol 2007; 116: 371–375.
33. Kavo AE, Rallidis LS, Sakellaropoulus GC et al. Qualitative characteristics of HDL in young patients of an acute myocardial infarction. Atherosclerosis 2012; 220: 257–264.
34. Jalowiec DA, Hill JA. Myocardial infarction in the young and in women. Cardiovasc Clin 1989; 20: 1197–2006.
35. Pineda J, Marin F, Roldan V et al. Premature myocardial infarction: Clinical profile and angiographic findings. Int J Cardiol 2008; 126: 127–129.
36. Zikmund V, Cagáň S, Riečanský I et al. Functional efficiency of the central nervous system and some personality characteristics in various age groups of patients with myocardial infarction. Activ Nerv Sup Praha 1982; 24 (Suppl 3): 168–172.
37. Breier P, Selko D, Zikmund V et al. Nervous and mental efficiency, neuroticism and type of behaviour in patients with CHD in various age groups. Activ Nerv Sup Praha 1983; 25: 211–213.
38. Migliaresi P, Celentano A, Palmieri V et al. Knowledge of cardiovascular risk factors and awareness of non-pharmacological approach for risk prevention in young survivors of acute myocardial infarction. The cardiovascular risk prevention project “Help Your heart Stay Young”. Nutrition, Metabolism and Cardiovascular Diseases 2007; 17: 468–472.
39. Iribarren C, Sidney S, Bild DE et al. Association of hostility with coronary artery calcification in young adults. JAMA 2000; 283: 2546–2551.
40. O’Flaherty M, Bishop J, Redpath A et al. Coronary heart disease mortality among young adults in Scotland in relation to social inequalities: time trend study. BMJ 2009; 339: 1–7.
41. Mattioli AV, Bonetti L, Zennaro M et al. Acute myocardial in young patients: nutritional status and biochemical factors. Int J Cardiol 2005; 101: 185–190.
42. Goliasch G, Blessberger H, Azar D et al. Markers of bone metabolism in premature myocardial infarction (≤ 40 years of age). Bone 2011; 48: 622–626.
43. Gaeta G, De Michele M, Cuomo S et al. Arterial abnormalities in the offspring of patients with premature myocardial infarction. N Engl J Med 2000; 343: 840–846.
44. Chen SM, Tsai TH, Hang CL et al. Endothelial dysfunction in young patients with acute ST-elevation myocardial infarction. Heart Vessels 2011; 26: 2–9.
45. Klein LW, Nathan S. Coronary artery disease in young adults. J Am Coll Cardiol 2003; 41: 529–531.
46. Raymond R, Lynch J, Underwood D et al. Myocardial infarction and normal coronary arteriography: A 10 year clinical and risk analysis of 74 patients. J Am Coll Cardiol 1988; 11: 471–477.
47. Fournier JA, Sánchez-Gonzáles A, Quero J et al. Normal angiogram after myocardial infarction in young patients: A prospective clinical-angiographic and long-term follow-up study. Int J Cardiol 1997; 60: 281–287.
48. Füllhaas JU, Rickenbacher P, Pfisterer M et al. Long-Term Prognosis of Young Patients after myocardial infarction in the thrombolytic rra. Clin Cardiol 1997; 20: 993–998.
49. Fournier JA, Cabezón S, Cayuela A et al. Long-term prognosis of patients having acute myocardial infarction when (≤ 40 years of age). Am J Cardiol 2004; 94: 989–992.
50. Awad-Elkarim AA, Bagger JP, Albers CJ et al. A prospective study of long term prognosis in young myocardial infarction survivors: the prognostic value of angiography and exercise testing. Heart 2003; 89: 843–847.
51. Chouhan L, Hajar HA, Pomposielo JC. Comparison of thrombolytic therapy for acute myocardial infarction in patients aged < 35 and > 55 years. Am J Cardiol 1993; 71: 157–159.
52. Van’t Hof AWJ, De Boer MJ, Suryapranata H et al. Incidence and predictors of restenosis after succesful primary coronary angioplasty for acute myocardial infarction: The importance of age and procedural result. Am Heart J 1998; 136: 518–527.
53. Shiraishi J, Shiraishi H, Hayashi H et al. Interventional treatment for very young adults with acute myocardial infarction. Int Heart J 2005; 46: 1–12.
54. Kofflard MJ, De Jaegere PP, Van Domburg Ret al. Immediate and long-term clinical outcome of coronary angioplasty in patients aged 35 years or less. Br Heart J 1995; 73: 82–86.
55. Mukherjee D, Hsu A, Moliterno DJ et al. Risk factors for premature coronary artery disease and determinants of adverse outcomes after revascularization in patients ≤ 40 years old. Am J Cardiol 2003; 92: 1465–1467.
56. Kubrycht M, Křížová A, Varvařovský I et al. Akutní infarkt myokardu u mladé ženy. Cor Vasa 2009; 51: 821–823.
57. Navas-Nacher EL, Colangelo L, Beam C et al. Risk factors for coronary heart disease in men 18 to 39 years of age. Ann Intern Med 2001; 134: 433–439.
58. Liu K, Daviglus ML, Loria CM et al. Healthy lifestyle through young adulthood and the presence of low cardiovascular disease risk profile in middle age. The coronary artery risk development in (young) adults (CARDIA) study. Circulation 2012; 125: 996–1004.
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Internal Medicine
2012 Issue 7 a 8
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