Characteristics and Long-Term Prognosis of Patients ≤35 Years of Age with ST Segment Elevation Myocardial Infarction and “Normal or Near Normal” Coronary Arteries

Rallidis, Lοukianos S.; Gialeraki, Argyri; Triantafyllis, Andreas S.; Tsirebolos, Georgios; Liakos, G.; Moutsatsou, Paraskevi; Iliodromitis, Efstathios K.

doi:10.1016/j.amjcard.2017.06.002

Cited by 19 publications

(7 citation statements)

References 22 publications

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“…However, in our analysis, this subgroup of patients had a four times higher incidence of MACE than the controls, with worse clinical outcomes compared to patients with significant CAD. The study by Radillis et al found a better prognosis for these patients than for those with obstructive disease [ 32 ]. However, the results of the VIRGO study refer to a similar prognosis for both groups [ 19 ].…”

Section: Discussionmentioning

confidence: 99%

Coronary Artery Disease in Very Young Patients: Analysis of Risk Factors and Long-Term Follow-Up

Juan-Salvadores

Díaz

Carreño

et al. 2022

JCDD

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Coronary artery disease (CAD) is a common chronic condition in the elderly. However, the earlier CAD begins, the stronger its impact on lifestyle and costs of health and social care. The present study analyzes clinical and angiographic features and the outcome of very young patients undergoing coronary angiography due to suspected CAD, including a nested case-control study of ≤40-year-old patients referred for coronary angiography. Patients were divided into two groups: cases with significant angiographic stenosis, and controls with non-significant stenosis. Of the 19,321 coronary angiographies performed in our center in a period of 10 years, 504 (2.6%) were in patients ≤40 years. The most common cardiovascular risk factors for significant CAD were smoking (OR 2.96; 95% CI 1.65–5.37), dyslipidemia (OR 2.18; 95% CI 1.27–3.82), and family history of CAD (OR 1.95; 95% CI 1.05–3.75). The incidence of major adverse cardiovascular events (MACE) at follow-up was significantly higher in the cases compared to controls (HR 2.71; 95% CI 1.44–5.11). Three conventional coronary risk factors were directly related to the early signs of CAD. MACE in the long-term follow-up is associated to dyslipidaemia and hypertriglyceridemia. Focusing efforts for the adequate control of CAD in young patients is a priority given the high socio-medical cost that this disease entails to society.

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Section: Discussionmentioning

confidence: 99%

Coronary Artery Disease in Very Young Patients: Analysis of Risk Factors and Long-Term Follow-Up

Juan-Salvadores

Díaz

Carreño

et al. 2022

JCDD

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“…This affiliation warranted studying the polymorphism but the current study was unable to associate it with CAD. The important predictors of CAD including the traditional risk factors such as cholesterol, and family history of CAD; the novel serum parameter homocysteine; and genetic polymorphisms in MTHFR gene, altogether are robustly allied to CAD in previous literature [17,33,40,50,51]. These parameters, in essence, achieved statistical significance with CAD in current study.…”

Section: Factorsmentioning

confidence: 51%

The Correlation of MTHFR SNPs, Homocysteine, and Conventional Risk Predictors with Coronary Artery Disease

Rizwan¹,

Khan²,

Baqai³

et al. 2021

Russ J Genet

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Arterial thromboembolic disease affects coronary vasculature and has an exhaustive list of etiologies. The aim of the present study was to investigate the effects of genetic variants in homocysteine pathway genes, homocysteine levels, and other modifiable and non-modifiable conventionally allotted risk factors for coronary artery disease. Study was retrospective case control study, comprised 404 participants (controls, n = 179, ischemic heart disease (IHD) patients, n = 89, and myocardial infarction (MI) cases, n = 136, respectively). Single nucleotide polymorphisms (SNPs); rs1801133, rs1801131 in methylenetetrahydrofolate reductase 'MTHFR' gene, rs1805087 in methyl tetrahydrofolate homocysteine methyltransferase 'MTR' gene, and rs662 in paroxanse1 'PON1' gene, rs4646994, angiotensin converting enzyme 'ACE' insertion/deletion (I/D) polymorphism were resolved employing conventional, and by tetra primer allele refractory mutation system polymerase chain reaction (PCR). ANOVA association testing revealed that homocysteine, cholesterol, creatinine, triglyceride levels, age, family history of CAD, and polymorphisms in MTHFR and PON1 related to coronary artery disease. The post HOC analysis also maintained significance differences in the control, ischemic heart disease and case groups respectively. The regression analysis failed to maintain statistical significance for creatinine, triglycerides, age, and rs662 PON1 polymorphism, whereby, serum homocysteine, cholesterol, family history, and rs1801133/rs1801131 MTHFR SNPs maintained statistical significance. The results from the present study provide hint into interlaced nature of traditional and novel risk factors in the causation of arterial disease and an insight into their shared detrimental effects in affecting the coronary vasculature.

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“…e prevalence of MINOCA is within 5-25% [8,9], closer to 6-10% in patients older than 40 years [9,10]. However, in young patients ≤35 years it is above 18%, which are the most affected population [11]. However, the characteristics of these very young patients have been poorly studied, and some classic risk factors for their clinical manifestation have not been defined.…”

Section: Introductionmentioning

confidence: 98%

Clinical Features and Long-Term Outcomes in Very Young Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries

Juan-Salvadores

Díaz

Araujo

et al. 2022

Journal of Interventional Cardiology

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Background. The main cause of acute coronary syndrome (ACS) is coronary artery obstruction due to atherosclerotic plaque growth or thrombus formation secondary to plaque rupture or erosion. However, there is a subgroup of patients with signs and symptoms suggestive of ACS but without relevant coronary artery obstruction on coronary angiography. This population is defined as myocardial infarction with non-obstructive coronary arteries (MINOCA). The present study analyzes the clinical features and outcomes of very young patients with a diagnosis of MINOCA. Method. Nested case-control study of ≤40-year-old patients referred for coronary angiography due to clinical suspicion of ACS. Patients were divided into three groups: patients with obstructive coronary artery disease (CAD), patients diagnosed with MINOCA, and controls with non-coronary artery disease. Results. Of 19,321 coronary angiographies performed in our center in a period of 10 years, 408 (2.1%) were in patients ≤40 years old, and MINOCA was identified in 32 (21%) patients. The cardiovascular risk factors for obstructive CAD and MINOCA were very similar. The incidence of major adverse cardiovascular events (MACE) at follow-up was significantly higher in the MINOCA (HR 4.13 (95%CI 1.22–13.89) and obstructive CAD (HR 4.59 (95%CI 1.90–10.99) patients compared to controls. Cocaine use HR 14.58 (95%CI 3.08–69.02), family history of CAD HR 6.20 (95%CI 1.40–27.43), and depression HR 5.16 (95%CI 1.06–25.24) were associated with a poor outcome in the MINOCA population. Conclusion. Very young patients with MINOCA had a poor prognosis at long-term follow-up, similar to patients with obstructive CAD. Focusing efforts on secondary prevention is essential in this population.

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Characteristics and Long-Term Prognosis of Patients ≤35 Years of Age with ST Segment Elevation Myocardial Infarction and “Normal or Near Normal” Coronary Arteries

Cited by 19 publications

References 22 publications

Coronary Artery Disease in Very Young Patients: Analysis of Risk Factors and Long-Term Follow-Up

Coronary Artery Disease in Very Young Patients: Analysis of Risk Factors and Long-Term Follow-Up

The Correlation of MTHFR SNPs, Homocysteine, and Conventional Risk Predictors with Coronary Artery Disease

Clinical Features and Long-Term Outcomes in Very Young Patients with Myocardial Infarction with Non-Obstructive Coronary Arteries

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