Comparison of thrombolytic therapy for acute myocardial infarction in patients aged &lt;35 and &gt;55 years

Chouhan, Lalit; Hajar, Hajar A.; Pomposiello, Juan Carlos

doi:10.1016/0002-9149(93)90731-q

Cited by 64 publications

(52 citation statements)

References 17 publications

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“…Studies of select cohorts of young patients with AMI have shown that young AMI patients have different demographics and risk factor profiles than older AMI patients. [8][9][10][11] For example, the majority of AMIs before age 40 occur in young men, as 81-94% of young AMI patients are male. [7][8][9][10][11][12] An increased number of risk factors are seen in younger AMI patients, with most young AMI patients (89-99%) having at least one cardiac risk factor.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11] For example, the majority of AMIs before age 40 occur in young men, as 81-94% of young AMI patients are male. [7][8][9][10][11][12] An increased number of risk factors are seen in younger AMI patients, with most young AMI patients (89-99%) having at least one cardiac risk factor. 7,9,10,12 Cigarette smoking is by far the most common risk factor in young AMI patients (62-94%), followed by family history of premature CAD (15-84%) and hyperlipidemia (20-61%).…”

Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12] An increased number of risk factors are seen in younger AMI patients, with most young AMI patients (89-99%) having at least one cardiac risk factor. 7,9,10,12 Cigarette smoking is by far the most common risk factor in young AMI patients (62-94%), followed by family history of premature CAD (15-84%) and hyperlipidemia (20-61%). [7][8][9][10][11][12] In contrast to the older AMI patients, less than 12% of young AMI patients have diabetes mellitus.…”

Section: Discussionmentioning

confidence: 99%

“…7,9,10,12 Cigarette smoking is by far the most common risk factor in young AMI patients (62-94%), followed by family history of premature CAD (15-84%) and hyperlipidemia (20-61%). [7][8][9][10][11][12] In contrast to the older AMI patients, less than 12% of young AMI patients have diabetes mellitus. [7][8][9][10][11][12] Young patients with AMI also differ from older patients in their extent of CAD.…”

Section: Discussionmentioning

confidence: 99%

“…6,7 Young AMI patients have different risk factor profiles, less CAD by angiography, and better outcomes than older patients with AMI. [6][7][8][9][10][11][12][13][14] The lower incidence of CAD in patients under 40 and the differences in the characteristics of CAD in this age group make young patients with chest pain a distinct subgroup of patients. The purpose of this study was to describe the incidence of ACS in young chest pain patients, their clinical presentation, hospital course, and outcome at 30 days.…”

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confidence: 99%

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Characteristics and Outcomes of Young Adults Who Present to the Emergency Department with Chest Pain

Walker

Sites

Shofer

et al. 2001

Academic Emergency Medicine

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Abstract.Background: Most studies of emergency department (ED) chest pain patients exclude patients <30-40 years old. As a result, the clinical course of these patients is poorly described. Objective: To study the clinical characteristics, hospital course, and 30-day outcomes of ED chest pain patients <40 years old. The hypothesis was that patients <40 years old without a cardiac history and with normal electrocardiograms (ECGs) or no cardiac risk factors would be at a <1% risk for acute coronary syndromes (ACSs) and 30-day adverse cardiovascular (CV) events. Methods: This was a prospective cohort study of noncocaine-using ED patients, 24-39 years old, who received an ECG for chest pain between July 9, 1999, and October 23, 2000. Structured data collection at presentation included demographics, chest pain description, history, laboratory, and ECG data. Hospital course was followed daily. Thirty-day follow-up was performed by telephone. The main outcomes were discharge diagnosis and 30-day adverse CV events [acute myocardial infarction (AMI), death, percutaneous intervention (PCI), or coronary artery bypass grafting (CABG)]. Results: A total of 487 patients presented 527 times and comprised the study group. Patients were most often 30-39 years old (71%), female (60%), and African-American (73%). Thirty-two percent were admitted. Five hundred seven of 527 patient visits (96%) had 30-day follow-up. Patients had the following cardiac risk factors: tobacco, 37%; hypertension, 22%; family history, 19%; diabetes mellitus, 6%; cholesterol, 6%; prior angina, 3%; known coronary artery disease, 3%; and prior AMI, 2%. Patients usually had unremarkable ECGs (61% normal, 98% nonischemic). Overall, 11 of 527 patients had adverse CV events (2.1%; 95% CI = 0.9% to 3.3%): 8 AMIs (1.5%), 4 deaths (0.8%), 5 PCIs (0.9%), and no CABG. Twenty-five patients had a final diagnosis of ACS (4.7%; 95% CI = 2.9% to 6.5%). The incidence of ACS in the 210 patients without a cardiac history and without cardiac risk factors was 0.5% (95% CI = 0% to 1.4%). At 30 days, none of these 210 patients had AMI, PCI, CABG, or death (0%, 95% CI = 0% to 1.4%). The incidence of ACS in the 312 patients with normal ECGs and a negative cardiac history was 0.3% (95% CI = 0% to 0.9%). At 30 days, there was no AMI, PCI, or CABG in these 312 patients, and one patient with metastatic cancer died (adverse CV event 0.3%, 95% CI = 0% to 0.9%). Conclusions: Although young patients, as a whole, have a 4.7% risk of ACSs and a 2.1% risk of adverse CV events at 30 days, those without known cardiac disease or any cardiac risk factors had a <1% risk of ACSs and were free from adverse CV events over 30 days. Likewise, young patients without a cardiac history and with a normal ECG had a <1% risk of ACSs and adverse CV events at 30 days. It may be reasonable to expedite outpatient management and limit unnecessary admissions in these cohorts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Characteristics and Outcomes of Young Adults Who Present to the Emergency Department with Chest Pain

Walker

Sites

Shofer

et al. 2001

Academic Emergency Medicine

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Epidemiologic Variables and Outcome of 1972 Young Patients With Acute Myocardial Infarction

Moccetti¹

1997

Arch Intern Med

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Myocardial infarction in men aged 40 years or less: A prospective clinical‐angiographic study

Fournier

Sánchez

Quero

et al. 1996

Clinical Cardiology

125

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SummaryH~potliesis: The study W L L~ undertaken to characterize acute myocardial infarction (AMI) in young patients.Mtvhods: In all, 108 consecutive Mediterranean patients with AM1 ( 102 men and 6 women), aged I 40 years, were prospectively included in this study over aperiod of6.S years. Coronary angiography was canied out within the first month and data from these patients with normal or diseased coronary arteries were compared. Clinical features, risk factors, and inhospital and late morbidity and mortality were evaluated. Kr.sirlts: Young patients with AM1 represent 4. I % of the 2,644 patients admitted because of definite AM1 during this period. The most coninion risk factors were cigarette smoking (94.5%) and hypercholesteroleinia (48%). Location of the AM1 was anterior in 37%. inferior in 57.5%. and non-Q in 5.5%. A history of previous angina was present in 42.5%' of the patients, including all seven patients with previous myocardial infarction (6.5%). However, in 52% of the patients the anginal episodes started i n the week prior to the AMI. Inhospital mortality and motzality during a mean follow-up of 4 1 -c 13 months were 3.7 and 3.870, respectively. The KaplanMeier actuarial curve assessed on 97 of 104 survivors was 100 a d 94% at I and 5 years, respectively. Coronary arteries were angiographically normal in I7 (20%) of 87 survivors. Compared with young patients who had obstructive lesions, this subset had a lower age and fewer risk factors, reinfarction (p

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Comparison of thrombolytic therapy for acute myocardial infarction in patients aged <35 and >55 years

Cited by 64 publications

References 17 publications

Characteristics and Outcomes of Young Adults Who Present to the Emergency Department with Chest Pain

Characteristics and Outcomes of Young Adults Who Present to the Emergency Department with Chest Pain

Epidemiologic Variables and Outcome of 1972 Young Patients With Acute Myocardial Infarction

Myocardial infarction in men aged 40 years or less: A prospective clinical‐angiographic study

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