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Myocardial infarction in young Indian patients: risk factors and coronary arteriographic profile
Insights
Young Indian patients experiencing myocardial infarction (MI) often have significant coronary artery disease (CAD) and multiple risk factors, particularly smoking. Detailed evaluation is crucial due to frequent normal coronary arteriograms in this demographic.
Area of Science:
- Cardiology
- Vascular Medicine
- Public Health
Background:
- Myocardial infarction (MI) in individuals under 40 is less common but carries significant implications.
- Understanding the characteristics of young MI patients is vital for early intervention and prevention strategies.
Purpose of the Study:
- To investigate the coronary artery disease (CAD) patterns and risk factors in young Indian patients (<40 years) presenting with MI.
- To compare risk factor prevalence in young MI patients with obstructive CAD versus those with normal coronary arteries.
Main Methods:
- Coronary arteriography was performed on 104 patients under 40 years old with MI.
- Patients were categorized into groups based on arteriography findings: obstructive CAD, normal coronary arteries, or ostial stenosis.
- Prevalence of traditional coronary risk factors was assessed for each group.
Main Results:
- Eighty patients (76.9%) had obstructive CAD, characterized by high rates of smoking (76.2%), hypercholesterolemia (36.3%), and hypertension (32.5%).
- Multiple risk factors were present in 56.2% of patients with obstructive CAD.
- Smoking was significantly more common (p<0.01) in young MI patients compared to older counterparts.
- Twenty-three patients (22.1%) had normal coronary arteries and few risk factors.
- One patient had coronary ostial stenosis without risk factors.
Conclusions:
- Young Indian patients with MI and obstructive CAD exhibit a high prevalence of coronary risk factors, notably smoking and multi-vessel disease.
- The frequent occurrence of normal coronary arteriograms in this population necessitates thorough evaluation for accurate prognosis and management.
- Findings highlight the need for targeted prevention and management strategies for cardiovascular disease in young adults.
Abstract:
One hundred four patients (101 men, three women), under 40 years of age, with myocardial infarction (MI), underwent coronary arteriography. Eighty patients had significant obstructive coronary artery disease (CAD) (group 1), 23 had normal coronary arteries (group 2), and one patient had coronary ostial stenosis as a result of nonspecific aortoarteritis (group 3). Coronary risk factors in group 1 included smoking (76.2%), hypercholesterolemia (36.3%), hypertension (32.5%), positive family history (28.7%), and diabetes mellitus (5%). Multiple risk factors were frequent (56.2%). Smoking was common (p less than 0.01) and diabetes mellitus less frequent (p less than 0.05) as compared to older (greater than 40 years) patients with MI and arteriographically proved CAD. The frequency of one-, two-, and three-vessel disease was 33.7%, 26.2%, and 40%, respectively, in group 1. Group 2 patients were almost devoid of coronary risk factors. The only group 3 patient had left coronary ostial stenosis with no risk factors. Similar to their counterparts in developed countries, young Indian patients with MI and obstructive CAD have a high frequency of coronary risk factors, especially smoking and severe multiple-vessel disease. Since normal coronary arteriograms are also frequent in this setting, a detailed evaluation is recommended for purposes of prognosis and management.