Acute myocardial infarction in sickle cell disease: a systematic review

Area of Science:

• Cardiology
• Hematology
• Internal Medicine

Background:

• Myocardial infarction (MI) in young adults is often a diagnosis of exclusion.
• Sickle cell disease (SCD) patients are disproportionately young and prone to crises, leading to overlooked MI.
• Traditional coronary artery disease risk factors and stratification tools (TIMI, GRACE) underestimate MI risk in SCD.

Purpose of the Study:

• To highlight the challenges in diagnosing MI in young adults with SCD.
• To discuss the diagnostic criteria, potential mechanisms, and management strategies for MI in SCD patients.
• To emphasize the need for increased awareness and revised diagnostic approaches for MI in this population.

Main Methods:

• Review of existing literature on MI in young adults and SCD.
• Analysis of diagnostic challenges, including atypical presentations and limitations of risk scores.
• Discussion of pathophysiological mechanisms linking SCD to cardiac events.
• Outline of current and potential management strategies.

Main Results:

• MI is often a missed diagnosis in SCD patients.
• Nonspecific electrocardiogram changes offer limited diagnostic value.
• SCD patients frequently lack traditional cardiovascular risk factors, complicating risk assessment.
• Existing risk stratification models are inadequate for identifying MI risk in SCD.

Conclusions:

• MI in young adults with SCD requires heightened clinical suspicion.
• Diagnostic criteria and risk assessment tools need adaptation for SCD patients.
• Understanding SCD-specific mechanisms is key to improving MI diagnosis and management.
• Prompt and appropriate management can improve outcomes for SCD patients experiencing MI.