Myocardial infarction in young people with normal coronary arteries

Williams, Michael J.A.; Restieaux, Norma J.; Low, Clive J.S.

doi:10.1136/hrt.79.2.191

Cited by 92 publications

(97 citation statements)

References 42 publications

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“…7,8,11,12 Theories for the etiology of AMI in young patients with normal coronary arteries include coronary artery spasm, and cocaine-and/or cigarette-smokinginduced vasoconstriction and platelet activation. 19 As would be expected, young AMI patients with normal coronary arteries have been found to have fewer cardiac risk factors than other young AMI patients. 7,8,11,12 The effect of this group of young AMI patients with normal coronary arteries on the evaluation of acute chest pain in patients <40 years old is unknown.…”

Section: Discussionmentioning

confidence: 63%

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: 63%

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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“…[1][2][3][4] However, novel functional polymorphisms in hemostasis/inflammation genes remain good candidates for a role in the pathogenesis of MI, 5 especially in younger patients in whom angiographically normal coronary arteries are more frequent and a positive family history of premature coronary disease is more prevalent than in older patients. 6,7 Inflammatory processes are a common underlying mechanism leading to coronary heart disease. Antiinflammatory mechanisms may, therefore, constitute an important protection against MI.…”

Section: Introductionmentioning

confidence: 99%

Endothelial protein C receptor polymorphisms and risk of myocardial infarction

Medina¹,

Navarro²,

Corral³

et al. 2008

Haematologica

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“…In addition, both smoking and alcohol have also been shown to provoke coronary artery spasm. 25,26) Some recent reports have shown that most younger AMI patients were heavy smokers. 5,6) In the current report, all patients were young male smokers and 3 of 5 patients suffered an AMI after drinking alcohol.…”

Section: Discussionmentioning

confidence: 99%

Interventional Treatment for Very Young Adults With Acute Myocardial Infarction: Clinical Manifestations and Outcome

Shiraishi¹,

Shiraishi²,

Hayashi

et al. 2005

Int. Heart J.

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SUMMARYDirect percutaneous coronary intervention (PCI) for acute myocardial infarction (AMI) is now established as a standard therapy for older patients. However, experience with PCI in very young adults with AMI has been limited. In this report we retrospectively evaluated the effectiveness of PCI for very young adults with AMI and estimated their clinical characteristics and outcome. Of the 502 patients with AMI, 5 were 35 years old or younger (1.0%) during a period of 4 years (2000)(2001)(2002)(2003)(2004). We assessed the utility of PCI in these five consecutive patients under the age of 35 presenting with a first AMI. Five AMI patients, ranging in age from 20 to 34 years (median, 27 ± 5 years) underwent direct PCI for the culprit lesions. The lesions targeted for PCI were located in the left anterior descending artery in 3 patients and in the right coronary artery in 2 patients. One patient had a past history of Kawasaki disease (KD). In all of the patients, PCI were angiographically effective at the acute phase without complication. In hospital course, a subacute stent thrombosis occurred in one patient. Follow-up angiograms performed 6 months after the procedure revealed no restenosis, but identified a new coronary aneurysm in one patient with a past history of KD and a regressed giant coronary aneurysm probably due to atypical KD in another patient, which were confirmed by intravascular ultrasound. There was one death ascribed to heart failure 8 months after the initial PCI. The findings of this report suggest that PCI for very young adults with AMI can be safe and effective in the short-term. (Int Heart J 2005; 46: 1-12) Key words: Percutaneous coronary intervention, Kawasaki disease, Coronary aneurysm, Intravascular ultrasound ACUTE myocardial infarction (AMI) is rare in young adults. Previous studies have estimated that young patients less than 45 years old make up between 2% and 10% of all AMIs.1) The etiology of their AMI varies but is usually not due toFrom the

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Myocardial infarction in young people with normal coronary arteries

Cited by 92 publications

References 42 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

Endothelial protein C receptor polymorphisms and risk of myocardial infarction

Interventional Treatment for Very Young Adults With Acute Myocardial Infarction: Clinical Manifestations and Outcome

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