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

Fournier, Juan A.; Sánchez, Ángel; Quero, J; Fernández-Cortacero, José A. Pérez; González-Barrero, A.

doi:10.1002/clc.4960190809

Cited by 125 publications

(124 citation statements)

References 26 publications

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“…The relatively high prevalence of acute myocardial infarction associated with normal coronary angiography was described in young patients (younger than 40 years of age) (17,18). Zimmerman et al (18) studied the angiographic characteristics, coronary risk factors and prognoses in young women and men with a history of myocardial infarction.…”

Section: Discussionmentioning

confidence: 99%

Prevalence of normal coronary angiography in the acute phase of suspected ST-elevation myocardial infarction: Experience from the PRAGUE studies

Widimský

Stellova

Groch

et al. 2006

Canadian Journal of Cardiology

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BACKGROUND: Acute ST-elevation myocardial infarction in patients with normal coronary arteries has previously been described, but coronary angiography in these patients was performed after the acute phase of the infarction. It is possible that these patients did not have normal angiograms during the acute phase (transient coronary thrombosis or spasm were usually suspected to be the cause). Information on the prevalence of truly normal coronary angiograms during the acute phase of a suspected ST-elevation myocardial infarction is lacking. PATIENTS AND METHODS:The PRimary Angioplasty in patients transferred from General community hospitals to specialized PTCA Units with or without Emergency thrombolysis-1 (PRAGUE-1) and PRAGUE-2 studies enrolled 1150 patients with ST-elevation acute myocardial infarction, in whom 625 coronary angiograms were performed within 2 h of the initial electrocardiogram. A simultaneous registry included an additional 379 coronary angiograms performed during the ST-elevation phase of a suspected myocardial infarction. Thus, a total of 1004 angiograms were retrospectively analyzed. A normal coronary angiogram was defined as one with the absence of any visible angiographic signs of atherosclerosis, thrombosis or spontaneous spasm. RESULTS: Normal coronary angiograms were obtained for 26 patients (2.6%). Among these, the diagnosis at discharge was a small myocardial infarction in seven patients (0.7%), acute (peri)myocarditis in five patients, dilated cardiomyopathy in four patients, hypertension with left ventricular hypertrophy in three patients, pulmonary embolism in two patients and misinterpretation of the electrocardiogram (ie, no cardiac disease) in five patients. Seven patients with small infarctions underwent angiography within 30 min to 90 min of complete relief of the signs of acute ischemia, and thus, angiograms during pain were not taken. None of the 898 patients catheterized during ongoing symptoms of ischemia had a normal coronary angiogram. Spontaneous coronary spasm as the only cause (without underlying coronary atherosclerosis) for the evolving infarction was not seen among these 898 patients. Thus, the causes of the seven small infarcts in patients with normal angiograms remain uncertain. CONCLUSIONS: The observed prevalence of normal coronary angiography in patients presenting with acute chest pain and ST elevations was 2.6%. Most of these cases were misdiagnoses, not infarctions. A normal angiogram during a biochemically confirmed infarction is extremely rare (0.7%) and was not seen during the ongoing symptoms of ischemia.

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Section: Discussionmentioning

confidence: 99%

Prevalence of normal coronary angiography in the acute phase of suspected ST-elevation myocardial infarction: Experience from the PRAGUE studies

Widimský

Stellova

Groch

et al. 2006

Canadian Journal of Cardiology

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“…[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%

“…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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“…On the other hand, severe impairment of the left main coronary artery was significantly greater in males. When considering age, Fournier et al 13 found that patients 40 years of age or younger accounted for 4.1% (108 out of 2,644 patients) of the patients admitted due to acute myocardial infarction. They were 102 males and 6 females.…”

Section: Discussionmentioning

confidence: 99%

Clinical and pathological assessment of 82 patients with cardiovascular diseases undergoing autopsy at the Hospital das Clínicas of the Faculdade de Medicina de Botucatu from 1988 to 1993

Oliveira¹,

Silva²,

Andrade³

et al. 2000

Arq. Bras. Cardiol.

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

Cited by 125 publications

References 26 publications

Prevalence of normal coronary angiography in the acute phase of suspected ST-elevation myocardial infarction: Experience from the PRAGUE studies

Prevalence of normal coronary angiography in the acute phase of suspected ST-elevation myocardial infarction: Experience from the PRAGUE studies

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

Clinical and pathological assessment of 82 patients with cardiovascular diseases undergoing autopsy at the Hospital das Clínicas of the Faculdade de Medicina de Botucatu from 1988 to 1993

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