Acute Myocardial Infarction in Young Adults: Study of Risk factors, Angiographic Features and Clinical Outcome

Abstract

Background and aims: Acute myocardial infarction below 45 years of age constitutes a specific subset of population having different risk factors and clinical features as compared to older patients. Pattern of coronary artery involvement and clinical outcome also varies suggesting different underlying pathophysiology. Better understanding this specific problem will lead to further improvement in management. Methods: One hundred and fifteen consecutive patients diagnosed as acute myocardial infarction and were below 45 years over the period of one year were enrolled in the study. Clinical parameters, risk factors, angiographic patterns were analysed. Patients were assessed daily during hospital stay to study in-hospital outcome and complications. Results: Out of total patients studied, 64.3% were smokers, 27.8% were hypertensive, 15.65% were diabetic and 9.6% had history of dyslipidemia. There was history of recreational drug abuse in 4.3% of patients. Most patients present as ST elevation myocardial infarction (87%). Majority of patients were in Killip class I (69.5%) at presentation in emergency. Single vessel disease (58.3%) was the most common finding in coronary angiography and 7.6% patients have normal or non obstructive coronary lesions. Complications include arrhythmia (6%), cardiogenic shock (5.2%) and mortality (1.7%). Conclusions: In young acute myocardial infarction patients, smoking is the single most important modifiable risk factor. Other conventional risk factors are less strongly associated than older patients. Young patients tend to have less extensive coronary artery lesions. In few patients, presence of normal or non obstructive coronary lesions would suggest possibility of different mechanism of myocardial necrosis. Overall, these patients had favourable outcome and better prognosis. Nepalese Heart Journal | Volume 10 | No.1 | November 2013| Pages 12-16 DOI: http://dx.doi.org/10.3126/njh.v10i1.9740

Acute ST-Elevation Myocardial Infarction in Young in Shahid Gangalal National Heart Centre, Kathmandu, Nepal

“…Our study showed 6.8% of patients were younger than 30 years which were slightly higher than few recent This may be the sign of increasing trend of young patients developing CAD. Our studyshowed male predominance of 83.3% which was in similar range to almost all the studies done in young CAD patients worldwide, 6,14,15,16 which can easily be explained by the fact that male gender is prone to CAD.…”

“…Many studies conducted across the globe in similar group of patients 7,9,17,18 have also found high rates of tobacco use among young CAD patients with percentage ranging from 70-90. Recent studies done in our centre by Tamrakar et al 14 showed that 64.3% of the patients consumed tobacco. Another study done by Adhikari et al 16 showed tobacco consumption in 70% of the patients.…”

Clinical and angiographic characteristics of young adult patients recovered from acute myocardial infarction

“…Гранично доба од 45 година користи се у већини студија којим се дефинишу млади болесници са коронарном болешћу и инфарктом миокарда 1 . Акутни инфаркт миокарда има ниску инциденцију у младих одраслих особа.…”

“…Већу учесталост STEMI у млађих особа од 30 до 45 година налазе и друге студије 2,13,1,14,15,16 . Такође је показана већа учесталост доње локализације инфаркта миокарда у односу на предњу, код млађих болесника од 45 година, за разлику од болесника старијих од 65 година где је инфаркт предње чешће заступљен од инфаркта доње локализације.…”

“…Акутни инфаркт миокарда код болесника млађих од 40 година живота, може настати због придружене вазоспастичне компоненте суперпониране на генетску предиспозицију за стварањем вулнерабилних плакова, у коронарним артеријама, у ових особа, која води у некрозу миокарда 7 , као и услед наркоманије, вирусног миокардитиса, хиперкоагулабилног стања или употребе контрацептивних средстава 1 . Екстреман физички напор може бити заједнички, најопштији фактор, у младих или у оних са нормалним коронарним артеријама, што указује на коронарни спазам као могућу етиологију акутног инфаркта миокарда у овим случајевима 7,12 .…”