Myocardial infarction in young adults: Angiographic characterization, risk factors and prognosis (coronary artery surgery study registry)

Zimmerman, Franklin H.; Cameron, Airlie; Fisher, Lloyd D.; Ng, Guseva

doi:10.1016/0735-1097(95)00254-2

Cited by 431 publications

(435 citation statements)

References 40 publications

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“…Around 5% of patients presenting with an ACS exhibit normal coronary angiograms, a proportion that is higher in young patients (8,32). Various mechanisms have been hypothesized, such as coronary spasm, and acquired or inherited coagulation disorders (9,33).…”

Section: Discussionmentioning

confidence: 99%

Detection of myocarditis by contrast‐enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis

Codreanu

Djaballah

Angioı̈

et al. 2007

Magnetic Resonance Imaging

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Purpose:To prospectively assess the use of cardiac MRI with delayed contrast enhancement (DCE) for identifying patients with active myocarditis among those presenting with acute coronary syndrome (ACS) but no coronary stenosis. Materials and Methods:A total of 27 consecutive patients (age ϭ 45 Ϯ 17 years; 14 male) presenting with ACS (chest pain, positive troponin-I) and no coronary stenosis, underwent cardiac MRI 9 Ϯ 7 days after pain onset and 8 Ϯ 5 months later (N ϭ 19). Steady-state free-precession pulse (SSFP) sequence was applied for the assessment of myocardial function and both inversion-recovery (IR) and SSFP sequences were used for analyzing the topography and extent of DCE areas. Rest sestamibi-gated-single photon emission CT (SPECT) was also systematically performed.Results: Subepicardial DCE pattern typical of acute myocarditis was documented in 12 patients (44%). Ischemic DCE pattern (transmural or subendocardial focal DCE) was documented in 12 of the 15 remaining patients (44%). Patients with subepicardial DCE had: higher C-reactive protein (CRP) levels (38 Ϯ 32 vs. 14 Ϯ 24 mg/mL; P ϭ 0.04), lower Framingham cardiovascular risk (3 Ϯ 3% vs. 9 Ϯ 5%; P Ͻ 0.001), lower incidence of perfusion SPECT defects (17% vs. 73%; P ϭ 0.01), higher left ventricular (LV) enddiastolic volume (77 Ϯ 16 vs. 64 Ϯ 10 mL/m 2 ; P ϭ 0.02), and higher regression of DCE areas at follow-up (-65 Ϯ 17% vs. -18 Ϯ 23%; P ϭ 0.002).Conclusion: DCE pattern of active myocarditis can be seen in patients presenting with ACS but no coronary stenosis.

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Section: Discussionmentioning

confidence: 99%

Detection of myocarditis by contrast‐enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis

Codreanu

Djaballah

Angioı̈

et al. 2007

Magnetic Resonance Imaging

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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%

“…Zimmerman et al (18) studied the angiographic characteristics, coronary risk factors and prognoses in young women and men with a history of myocardial infarction. These authors reported normal coronary angiography, or nonobstructive disease, in 34% of young women and 22% of young men.…”

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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“…The concept of vulnerable plaque established in the general population clearly requires verification in regard to young and very young patients. In the 1988 study by Wolfe and Vacek [13], comparing angiographic characteristics of the coronary arteries in patients with MI aged ≤ 35 years vs. ≥ 55 years, a nearly complete coronary occlusion was found in all young patients with an abnormal coronary angiogram. Although that study included only 35 patients ≤ 35 years, this finding was highlighted by the authors and is consistent with our study findings.…”

Section: Discussionmentioning

confidence: 99%

Clinical and angiographic characteristics of coronary artery disease in young adults: a single centre study

Maroszyńska-Dmoch

Wożakowska−Kapłon

2016

Kardiol Pol

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A b s t r a c tBackground: Coronary artery disease (CAD) in young adults under 40 years of age is a growing medical, social, psychological and economical problem, related to the prevalence of civilization-related diseases and unhealthy lifestyle. The problem of CAD in young people has not been characterised as well as in older individuals, as the available data mostly come from case reports and small series, often related to genetic aspects and familial occurrence of the disease. Aim:To assess clinical and angiographic characteristics of young adults with CAD and to evaluate in-hospital and long-term mortality in this patient group. The study combined a retrospective and a prospective approach.Methods: A total of 239 patients aged 40 years or younger who underwent coronary angiography (CAG) in the Swietokrzyskie Centre of Cardiology in Kielce in [2001][2002][2003][2004][2005][2006][2007][2008] were included in this study. Demographic characteristics, risk factor profile, laboratory test results, electrocardiographic and echocardiographic findings, CAG findings, and in-hospital mortality were assessed retrospectively in the selected groups. During the second stage of the study, clinical and mortality data were obtained prospectively in 130 patients (54.4% of the study group) during up to 5 years of follow-up. Results:The mean patient age was 35.1 ± 4.4 years. Men made up 86.2% of the study sample, and the proportion of rural area residents was 54.8%. Among young patients with acute coronary syndromes (ACS), the most common presentation (52.8%) was ST segment elevation myocardial infarction (STEMI). Angiographically normal coronary arteries were found in 37.2% of CAD patients and in 16.9% of patients with the diagnosis of ACS. The mean degree of coronary artery lumen stenosis was 75.4% in the group with significant atherosclerotic coronary lesions (50-90%) and 95.9% in the group demonstrating a critical coronary obstruction (≥ 90%). Single-vessel disease was identified in 61.9% of patients with a positive result of CAG (stenosis > 50%, CORO(+) group). The most common location of significant atherosclerotic coronary lesions was the left anterior descending artery (61.6%) followed by the right coronary artery (27.4%). The most prevalent conventional cardiovascular risk factors were lipid abnormalities, cigarette smoking and an increased body mass index ≥ 25 kg/m 2 , followed by a family history of CAD and hypertension. The proportion of patients with abnormal lipid profile, cigarette smoking and overweight or obesity was particularly high in the CORO(+) group (85.6%, 83.9%, and 64.4%, respectively). In-hospital mortality rate was low, at 0.7% among ACS patients. Long-term mortality during up to 5 years of follow-up was not so favourable, at 7.75% in ACS patients and 8.5% in the CORO(+) group. Conclusions:The population of young patients with CAD is predominantly male, rural, and characterised by a low socioeconomic status. The aetiology of CAD in this patient group differs significantly from that in older patients a...

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Myocardial infarction in young adults: Angiographic characterization, risk factors and prognosis (coronary artery surgery study registry)

Abstract: Young patients with a myocardial infarction have a favorable prognosis compared with that in older patients.

Cited by 431 publications

References 40 publications

Detection of myocarditis by contrast‐enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis

Detection of myocarditis by contrast‐enhanced MRI in patients presenting with acute coronary syndrome but no coronary stenosis

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

Clinical and angiographic characteristics of coronary artery disease in young adults: a single centre study

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