Myocardial Infarction under age 40: Risk factors and Coronary Arteriographic findings

Objective: To evaluate risk factors and arteriography findings in young patients under 40 year of age admitted with first acute myocardial infarction (AMI). Design: A prospective descriptive study. Place and Duration of Study: Cardiology Department, Allama Iqbal Medical College/ Jinnah Hospital, Lahore from July 2002 to June 2003. Patients and Methods: During the study period, 274 patients with first AMI were admitted in our coronary care unit and 52 (19%) were under 40 year of age. These 52 patients underwent pre-discharge coronary arteriography. Results: Forty-five (87%) were male and seven (13%) were female. Risk factors in all study patients were smoking in 79%, systemic hypertension in 35%, diabetes mellitus in 31%, hyperlipidemia in 19% and family history of premature coronary artery disease in 17%. Risk factors were distinctly less frequent in patients without coronary atherosclerosis. Cigarette smoking was the main risk factor in male patients while diabetes and hypertension were main risk factors in female patients. Forty-six patients (88%) had significant CAD (greater than 50% diameter narrowing of at least one major coronary artery), 5(10%) had normal coronary arteries and one patient (2%) had marked coronary ectasia. In patients with significant coronary artery disease, the prevalence rate of one, two and three vessel disease was 52, 28 and 20 percent, respectively. No patient had congenital coronary anomaly or significant left main CAD. Conclusion: AMI in persons under the age of 40 years accounts for approximately 19% of AML In this age group, AMI is a disease of men who smoke & single vessel CAD predominates. Approximately half of the young patients have single vessel coronary disease, and in up to 10%, the cause is not related to atherosclerosis. Coronary angiography may be warranted in young patients with AMI to define the anatomy of the disease and to permit optimal management

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Angiographic profile of young patients (≤ 40 years) in a tertiary care center of Nepal

Asian Journal of Medical Sciences ◽

10.3126/ajms.v11i6.30163 ◽

2020 ◽

Vol 11 (6) ◽

pp. 68-71

Author(s):

Binay Kumar Rauniyar ◽

Arun Kadel ◽

Kiran Prasad Acharya ◽

Kartikesh Kumar Thakur ◽

Rakesh Bahadur Adhikari ◽

...

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Tertiary Care ◽

Significant Coronary Artery Disease ◽

Young Patients ◽

Vessel Disease ◽

Single Vessel ◽

Triple Vessel Disease ◽

Artery Disease ◽

Single Vessel Disease

Background: With rise in prevalence of conventional risk factors like diabetes, hypertension, smoking, dyslipidemia and obesity the incidence of coronary artery disease in young patients have increased in the recent decades even in developing world. There have been multiple studies done in Nepal studying the angiographic profile of coronary disease in general population. However, only few studies has been done till date on the angiographic profile in the young population in our country. Aims and Objectives: In this study, we aim to determine the angiographic profile of young patient ≤ 40 years in a tertiary care centre of Nepal. Materials and Methods: A retrospective analytic study was done in Shahid Gangalal National Heart Centre from January 2019 to December 2019. Individuals of both genders with age ≤ 40 years who underwent coronary angiography were included. Results: Total 109 patients were included. Out of 109, 89 were male and 20 were female. The mean age for male was 35.55 ± 4.31 and for female was 38.55 ± 1.90 (P = 0.003). Among 61 (55.96%) patients who had significant coronary artery disease, 33 patients (30.27%) with single vessel disease, 15 patients (13.76%) had double vessel disease, and 13 patients (11.92%) had triple vessel disease. Left anterior descending (LAD) artery was found to be most frequently involved in all patterns of Coronary artery disease (CAD). Smoking was the most common coronary risk factor present in 29.3% of patients followed by hypertension, family history of premature CAD and diabetes in 14.6%, 7.5% and 5.5% of patients respectively. Overall, the prevalence of smoking was more in males (31.4%) than in females (20%). Conclusion: Single vessel disease (SVD) was most prevalent in young patients with significant CAD. LAD is the most commonly involved coronary artery followed by Right coronary artery (RCA) and Left Circumflex (LCX).

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ID: 68: CORONARY ARTERY DISEASE AND ACUTE CORONARY SYNDROME IN PATIENTS ≤40 YEAR OLD

Journal of Investigative Medicine ◽

10.1136/jim-2016-000120.6 ◽

2016 ◽

Vol 64 (4) ◽

pp. 913.2-914

Author(s):

H Alkhawam ◽

R Sogomonian ◽

N Vyas ◽

A Al-khazraji ◽

S Ahmed ◽

...

Keyword(s):

Risk Factors ◽

Coronary Artery Disease ◽

Risk Factor ◽

Coronary Artery ◽

Premature Coronary Artery Disease ◽

Modifiable Risk Factors ◽

Coronary Syndrome ◽

Vessel Disease ◽

Single Vessel ◽

Artery Disease

BackgroundCoronary artery disease (CAD) in the younger adult population has been commonly under-represented in clinical practice and research studies given its early latent asymptomatic course, in addition to the underestimation of this population's CHD lifetime risk by commonly used CHD risk predictors such as Framingham's score.ObjectiveTo assess the risk factor profile for premature coronary artery disease CAD and ACS presentation in younger adults.MethodsRetrospective chart analysis of 393 patient's ≤40 years old admitted from 2005 to 2014 for chest pain and underwent coronary angiography. The implication of modifiable risk factors and non-modifiable risk factors were evaluated in those with obstructive CAD (LM stenosis of ≥50% or stenosis of ≥70% in a major epicardial vessel), non-obstructive CAD (≥1 stenosis ≥20% but no stenosis ≥70%) and normal coronaries (no stenosis >20%). Additionally we evaluated the impact of the same risk factors on ACS presentation (NSTEMI vs STEMI) and the extent of CAD (single-vessel/multi vessel).ResultsOf 9012 patients who underwent cardiac catheterization, 393 (4.3%) patients were ≤40 years old.Out of 393, 212 (54%) had CAD (153 obstructive versus 59 non-obstructive) while 185 (46%) had normal coronaries.Fifty two (25%) patients presented with STEMI while 140 (66%) patients presented with NSTEMI.Of 153 patients with obstructive CAD, 87 (57%) patients had single vessel disease vs 66 (43%) multiple vessel disease.When compared to patients with normal coronaries patients with CAD were more likely to be smokers (p<0.0001), dyslipidemia (p<0.0001), Diabetic (p<0.0001) cocaine users (p 0.4) have a family history of premature CHD (<0.0001) and be males (p<0.0001) (figure=1).Smokers were more likely to present with acute coronary syndrome; 5 times more likely to present with STEMI (p<0.0001) and 1.7 with NSTEMI (p 0.0003) compared to the control group.When compared head to head, smokers were 2.2 times more likely to present with STEMI compared to NSTEMI (p<0.001).Smoking also, alone and with another risk factor increased the risk of obstructive versus no obstructive CAD (p=0.04 and 0.015, respectively).No significant difference was noted in the single vessel vs multi vessel CAD subgroups.Coronary artery disease was highest in South Asian population (38.4%), followed by Hispanic (13.7%), African-American (10%) and Caucasian (9%). The main in risk factors in African–American was Hyperlipidemia +/− Diabetes (47.8%) while the main risk factors in Hispanic and white were smoking alone (24.14% and 47.4% respectively). In East Asia population, Smoking with hyperlipidemia was the main risk factors (44%).ConclusionIn our population of young adults, smoking as a single risk factor was the most prevalent for earlier CAD. It was also associated with more STEMIs and obstructive CAD. Healthcare intervention in the general population through screening, counseling and education regarding smoking cessation is warranted to reduce premature coronary artery disease. Abstract ID: 68 Figure 1

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Comparison of Risk Factors & Angiographic Profiles between Young Patients with ST Segment Elevation Myocardial Infarction and Non-ST Segment Elevation Myocardial Infarction

Bangladesh Heart Journal ◽

10.3329/bhj.v36i2.56038 ◽

2021 ◽

Vol 36 (2) ◽

pp. 124-132

Author(s):

Sayeedur Rahman Khan ◽

Fazila Tun Nesa Malik ◽

Mir Nesaruddin Ahmed ◽

Asim Kumar Biswas ◽

Mainul Islam ◽

...

Keyword(s):

Risk Factors ◽

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Young Patients ◽

St Segment Elevation ◽

Vessel Disease ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Artery Disease

Background: Coronary artery disease is the leading cause of death in the world. Advancing age is a well-recognized risk factor for acute myocardial infarction (AMI). Myocardial infarction is less common in young adults. Prevalence of acute coronary syndrome in young individuals is increasing progressively. These patients have different risk profile, presentation and prognosis. Early recognition and risk factor modification in this population sub-set is of key importance. Objectives: The purpose of the present study was to determine the differences in risk factors and coronary angiographic profile of young patients with ST-segment elevated myocardial infarction (STEMI) vs. those with non-ST-segment elevated myocardial infarction (NSTEMI). Methods: In this cross sectional analytical study total 135 patients (70 STEMI and 65 NSTEMI) aged ≤45 years were enrolled to see the differences of risk factors and angiographic profile. Results: The mean age of the study population was 39.39±5.12 years and the study showed male predominance (90.40 % was male and 9.60 % was female). Smoking/tobacco consumption was significantly higher in STEMI patients, whereas diabetes mellitus and hypertension were more prevalent in NSTEMI patients. The frequency of single vessel disease and involvement of left anterior descending artery was significantly higher in young STEMI patients. In case of young NSTEMI patients frequency of triple vessel disease, noncritical coronary artery disease and involvement of left circumflex coronary was significantly higher. The frequency of double vessel disease and involvement of left main coronary artery was also nonsignificantly higher in young NSTEMI patients. There was no significant difference regarding involvement of right coronary artery. Conclusion: There are significant differences between young STEMI and young NSTEMI patients in respect to risk factors and angiographic profile. Key words: Young patient, STEMI, NSTEMI, Risk factors, Coronary angiographic profile. Bangladesh Heart Journal 2021; 36(2): 124-132

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PREDICTORS OF MULTIVESSEL CORONARY ARTERY DISEASE IN YOUNG PATIENTS PRESENTING WITH ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION

Pakistan Heart Journal ◽

10.47144/phj.v54i3.2168 ◽

2021 ◽

Vol 54 (3) ◽

pp. 268-272

Author(s):

Ayaz Mir ◽

Syed Zia Ullah ◽

Atif Sher Muhammad ◽

Faiza Farooq ◽

Ali Ammar ◽

...

Keyword(s):

Myocardial Infarction ◽

Coronary Artery Disease ◽

Coronary Artery ◽

Young Patients ◽

Baseline Risk ◽

Premature Coronary Artery Disease ◽

St Segment Elevation ◽

Segment Elevation Myocardial Infarction ◽

St Segment ◽

Artery Disease

Objectives: Premature coronary artery disease (CAD) is on the rise in our population, and multivessel disease (MVD) is no longer an uncommon finding in young patients. Therefore, aim of this study was to determine the predictors of MVD in young patients who presented with ST-Segment Elevation Myocardial Infarction (STEMI). Methodology: For this study, we enrolled 294 young adult (18-40 years) patients with STEMI. MVD was diagnosed based on angiography. Demographic characteristics and baseline risk profiles were considered for the univariate and multivariate analyses to determine the predictors of MVD. Results: Out of 294 patients, 90.5% (266) were males, and the mean age was 35.45 ± 4.07 years. Our 24.1% (71) patients were hypertensive (HTN), and 36.1% (106) were smokers. A total of 94 patients had MVD. Patients with MVD were older and more likely to have diabetes (DM) and HTN than their counterparts. Only age and DM were found to be significant independent predictors of MVD. The risk of developing MVD was higher in diabetics, with adjusted odds ratios (ORs) [95% CI] of 2.47 [1.23-4.97; p=0.011]. Conclusion: In conclusion, we showed that age and DM are independent predictors of MVD in a young Pakistani adult population presenting with STEMI. However, none of the other risk factors, such as obesity, male gender or smoking, were found to be significantly associated with MVD in Pakistani adults with premature CAD. Although significantly associated, HTN does not prove to be an independent predictor of multivessel CAD in young adults.

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