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[Acute myocardial infarction in patients under 40 years of age]
L F Tanajura1, L S Piegas, A Timerman
1Instituto Dante Pazzanese de Cardiologia, São Paulo.
Insights
Young patients experiencing acute myocardial infarction (AMI) have a low in-hospital mortality rate. Survivors of AMI show a favorable long-term prognosis, with most remaining asymptomatic.
Area of Science:
- Cardiology
- Internal Medicine
Context:
- Acute myocardial infarction (AMI) in individuals under 40 is uncommon but warrants investigation.
- Understanding the prognosis of young AMI patients is crucial for effective long-term management.
Purpose:
- To evaluate the short-term and long-term prognosis of patients aged 40 and under who experienced their first acute myocardial infarction.
Summary:
- A 15-year study of 73 patients (90% male, mean age 35) with first AMI revealed key risk factors: smoking (88%), hypertension (22%), hypercholesterolemia (16%), and diabetes (4%). In-hospital mortality was 5%. Long-term follow-up (up to 15 years) showed a 74% overall survival rate, with 71% asymptomatic and 7% experiencing reinfarction.
- Coronary angiography indicated significant lesions in 88% of patients, with 60% having single-vessel disease and 28% multivessel disease.
Impact:
- This study highlights that young patients with acute myocardial infarction have a better prognosis than previously thought.
- Findings suggest that aggressive risk factor modification and timely intervention can lead to favorable long-term outcomes in this demographic.
Purpose:
To evaluate the short and long-term prognosis of a group of patients aged 40 and under, who developed an acute myocardial infarction.
Patients And Methods:
In the last 15 years we studied a group of 73 patients aged 40 and under with a confirmed diagnosis of first acute myocardial infarction. Patients with infarctions caused by coronary embolisms or to revascularization procedures were excluded.
Results:
Ninety percent were male and mean the age was 35. The most frequent risk factors observed were cigarette smoking in 64 (88%), hypertension in 16 (22%), hypercholesterolemia in 12 (16%) and diabetes in 3 (4%). Seven (9%) patients had no risk factors. The myocardial infarction was anterior em 50 (68%) cases and inferior in the remaining 23 (32%). Severe heart failure (Killip III and IV) was present in 3 (4%). Angiographic studies were performed in 63 (86%). Cineangiography showed critical coronary lesions (obstruction greater than 70%) in one vessel in 38 (60%) patients, multivessel disease in 18 (28%) and 7 (12%) had normal coronary vessels. In-hospital mortality was 5% (3 patients died due to severe heart failure and 1 due to cerebro-vascular accident). The 56 survivors were followed-up to 15 years, with overall survival of 74%. Fourty-nine (71%) were asymptomatic and 7 (10%) had recurrent chest pain. There were 7 (10%) late deaths and follow-up was lost in 6 (9%). Reinfarctions were observed in 5 cases (7%). Revascularization procedures were performed in 12 (17%) patients (bypass-graft surgery in 9 and coronary angioplasty in 3).
Conclusion:
Young patients with acute myocardial infarction have a low mortality rate in the early phase and a favorable outcome after the discharge of the hospital.