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[Routine coronary arteriography in younger patients with acute myocardial infarction]
1Kardiologisk laboratorium, medicinsk afdeling B, og kardiovaskulaert afsnit, radiologisk afdeling X, Rigshospitalet, København.
Insights
Coronary arteriography is not routinely recommended for all young patients with acute myocardial infarction (AMI). The procedure may be more beneficial when guided by symptoms or non-invasive test results.
Area of Science:
- Cardiology
- Interventional Cardiology
Background:
- Acute myocardial infarction (AMI) in patients under 40 is uncommon.
- Risk factors for ischemic heart disease are prevalent in young AMI patients.
Observation:
- Coronary arteriography (CAG) was performed on 50 patients under 40 with AMI.
- Smoking and family history were common risk factors.
- Stenosis patterns varied, with single-vessel disease most common; three-vessel disease was associated with post-infarction ischemia.
Findings:
- The type of myocardial infarction (Q-wave vs. non-Q-wave) correlated with the number of stenosed coronary arteries.
- Anomalous left coronary artery origin from the pulmonary artery was a rare cause of AMI.
- CAG is not indicated routinely for all young AMI patients.
Implications:
- Coronary arteriography decisions in young AMI patients should be based on clinical presentation and non-invasive findings.
- This study informs the selective use of invasive cardiac procedures in younger populations experiencing heart attacks.
Abstract:
Coronary arteriography was performed in 50 patients aged 40 years of less all of whom had had acute myocardial infarction (AMI). Forty-seven patients had at least one risk factor for development of ischaemic cardiac disease. Smoking and familial predisposition were the commonest predisposing factors. Seventeen patients had stenosis in a single coronary artery only. Six patients had three-vessel disease and none had stenosis of the main stem of the left coronary artery. Eight patients had no stenoses. All patients with three-vessel disease had sign of ischaemia after infarction. The type of infarction was related to the number of stenosed vessels, so that patients with Q-wave infarction had a greater number of stenoses than patients with non-Q-wave infarcts. A congenital coronary in the form of abnormal origin of the left coronary artery from the pulmonary artery was the cause of AMI in an isolated case. On the basis of this retrospective investigation, the authors have assessed the value of routine coronary arteriography (CAG) in 50 relatively young patients who had recently sustained AMI. CAG does not appear to be indicated as a routine procedure in all of these patients but could have been performed primarily on the basis of symptoms or the findings from non-invasive investigations.