Thrombophilic state in young patients with acute myocardial infarction

Abstract

The prevalence of thrombophilia and dyslipidemia among young survivors of acute coronary syndrome has not been clearly defined. The purpose of the current study was to investigate the prevalence of multiple markers of thrombophilia and dyslipidemia in a cohort of consecutive young survivors of acute coronary syndrome. The study cohort included 156 consecutive young patients (men <45 and women <50 years), admitted to the intensive cardiac care unit with newly diagnosed acute coronary syndrome. Analysis included baseline, clinical and epidemiological characteristics, angiographic coronary anatomy, echocardiographic evaluation, extensive lipid and thrombophilia laboratory profiles, and in-hospital and 1-year clinical outcomes for all patients. Acute myocardial infarction was diagnosed in 142 (92 %) patients, of whom 108 (72 %) had ST-segment elevation. Eighteen (12 %) patients had no traditional risk factors. Low levels of high-density lipoprotein (<40 mg/dL) were found in 101 (65 %) patients, and 49 (34 %) patients had elevated levels of lipoprotein(a) (Lp(a)) (>30 mg/dL). Eighteen (12 %) patients were diagnosed with antiphospholipid antibody syndrome (APS), and 73 (47 %) had at least one laboratory finding consistent with thrombophilia. Patients with APS had significantly higher levels of Lp(a) (46 ± 32 vs. 29 ± 31 mg/dL, p = 0.005). APS is a common prothrombotic state found in young survivors of acute coronary syndrome. Lp(a) levels are elevated among APS patients who present with premature acute coronary syndrome.

Hypertension Is an Independent Predictor of Multivessel Coronary Artery Disease in Young Adults with Acute Coronary Syndrome

“…Previous investigations have reported that young ACS patients have a different risk factor profile compared with elderly ACS patients [ 7 , 22 – 24 ]. Hypertension is a known important risk factor for the development of coronary artery disease [ 25 ].…”

A 16-year-old with ST elevation myocardial infarction: case report and review of the literature

“…25 Multiple reports have also demonstrated the role of antiphospholipid antibody syndrome antibodies in accelerating the process of coronary atherosclerosis. 26 Hypertension Although a well-established risk factor, hypertension was less likely to be present in younger patients. 30 This observation is consistent with recent studies; however, consistent with angiographic data of coronary artery disease in the young showing a stronger predilection for single-vessel disease and in particular left main disease, hypertension is common in patients with left main coronary artery stenosis who are under the age of 45 years.…”

Myocardial Infarction with Non-Obstructive Coronary Arteries: Contemporary Diagnostic and Management Approaches

“…При обследовании 156 молодых пациентов (мужчины <45 лет, женщины <50 лет) с ИМ E. Maor с соавт. выявили наличие, по крайней мере, одного лабора-торного показателя, соответствующего возможной тромбофилии в 47% случаев [38]. В популяции ИМбОКА наиболее часто выявляются резистентность фактора V Лейдена, а также дефицит активированного протеина C (у 12% и 3% пациентов, соответственно) [7].…”