Prevalence of factor V Leiden (APCR) and other inherited thrombophilias in young patients with myocardial infarction and normal coronary arteries

Abstract

Objective-To investigate the role of activated protein C resistance (APCR, factor V Leiden) in coronary artery thrombosis. Methods-The prevalence of APCR and of congenital deficiencies of antithrombin III, protein C, protein S, plasminogen, and factor XII was investigated in adult patients under 45 years of age with acute myocardial infarction. The results were compared with those of a group of 53 age and sex matched control subjects. Results-Among 75 patients under the age of 45 years who were admitted from November 1994 to April 1996 for acute myocardial infarction, 22 (29.3%) had normal coronary arteriography (group I) and 53 (70.7%) had significant coronary artery disease (group II). Inherited thrombophilia was more often found in group I (4/22, 18.2%) than in group II (4/53, 7.5%) but the diVerence was not significant (F test: p = 0.22). The prevalence of APCR was 9.1% (2/22) in group I, 3.8% (2/53) in group 2 (p = 0.57), and 3.8% (2/53) in the normal control group (p = 0.57). Conclusions-The prevalence of congenital thrombophilias, including APCR, does not seem to be increased in young patients with myocardial infarction and normal coronary angiograms, compared with young patients with coronary atherosclerosis and with normal control subjects. However, the statistical power of the study is too low to detect a significant diVerence and these results are published to allow a meta-analysis of this problem in the future. (Heart 1998;80:338-340)

Coronary Artery Spasm as a Frequent Cause of Acute Coronary Syndrome

“…Study limitations. We did not evaluate coagulation abnormalities that were previously reported in some cases as a cause of ACS (21). However, our aim was not to provide all-encompassing information about possible causes of chest pain in patients without culprit lesion but to focus on the role of coronary spasm reproduced by ACH testing.…”

Are patients with angiographically near-normal coronary arteries who present as acute myocardial infarction actually safe?

“…In our study, the incidence of near-normal coronary artery was 4.4%, consistent with previous reports. The main cause for AMI in near-normal coronary arteries is idiopathic, with possible causes that include coronary vasospasms [13][14][15][16][17], myocardial bridge [5,18], myocarditis [4,5,19,20], stress-induced cardiomyopathy [5,21,22], hypercoagulable states [5,23,24], pulmonary embolism [4], alcohol [5,25] or cocaine [5,26] abuse, contraceptive pill usage [5], and malignancy [3]. The causes of AMI with near-normal coronary angiogram in the present study are summarized in Fig.…”

Myocardial Infarction and Normal Coronary Arteries: The Experience of the Cardiology Department of Sfax, Tunisia

“…Owing to the small size of the population sample in previous studies, there is no conclusive answer (26)(27)(28). A multicentre study has found a higher prevalence rate of factor V Leiden in patients with myocardial infarction and normal coronary arteries.…”