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Myocardial infarction in men aged 40 years or less: a prospective clinical-angiographic study
J A Fournier1, A Sánchez, J Quero
1Cardiology Service, University Hospital Virgen del Rocio, Seville, Spain.
Insights
Young patients experiencing acute myocardial infarction (AMI) are often heavy smokers and may have normal coronary arteries. Their short- and long-term prognosis following AMI is generally excellent.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Acute myocardial infarction (AMI) typically affects older individuals.
- Characterizing AMI in younger populations is crucial for understanding unique risk factors and outcomes.
- Younger patients with AMI represent a distinct clinical subgroup requiring specific attention.
Purpose of the Study:
- To characterize acute myocardial infarction (AMI) in young patients (<= 40 years).
- To identify clinical features, risk factors, and outcomes in this demographic.
- To compare outcomes between young AMI patients with normal versus diseased coronary arteries.
Main Methods:
- Prospective study of 108 consecutive young Mediterranean patients with AMI over 6.5 years.
- Coronary angiography performed within one month of admission.
- Evaluation of clinical features, risk factors, in-hospital, and late morbidity and mortality.
Main Results:
- Young AMI patients constituted 4.1% of all AMI admissions.
- Key risk factors included cigarette smoking (94.5%) and hypercholesterolemia (48%).
- 17 (20%) of survivors had angiographically normal coronary arteries, with better outcomes regarding reinfarction and angina compared to those with obstructive lesions.
Conclusions:
- Young patients with AMI are frequently heavy smokers.
- A significant proportion of young AMI patients exhibit normal coronary arteries.
- The short- and long-term prognosis for young patients with AMI is excellent.
Hypothesis:
The study was undertaken to characterize acute myocardial infarction (AMI) in young patients.
Methods:
In all 108 consecutive Mediterranean patients with AMI (102 men and 6 women), aged < or = 40 years, were prospectively included in this study over a period of 6.5 years. Coronary angiography was carried out within the first month and data from these patients with normal or diseased coronary arteries were compared. Clinical features, risk factors, and in-hospital and late morbidity and mortality were evaluated.
Results:
Young patients with AMI represent 4.1% of the 2,644 patients admitted because of definite AMI during this period. The most common risk factors were cigarette smoking (94.5%) and hypercholesterolemia (48%). Location of the AMI was anterior in 37%, inferior in 57.5%, and non-Q in 5.5%. A history of previous angina was present in 42.5% of the patients, including all seven patients with previous myocardial infarction (6.5%). However, in 52% of the patients the anginal episodes started in the week prior to the AMI. In-hospital mortality and mortality during a mean follow-up of 41 +/- 23 months were 3.7 and 3.8%, respectively. The Kaplan-Meier actuarial curve assessed on 97 of 104 survivors was 100 and 94% at 1 and 5 years, respectively. Coronary arteries were angiographically normal in 17 (20%) of 87 survivors. Compared with young patients who had obstructive lesions, this subset had a lower age and fewer risk factors, reinfarction (p < 0.05), and late angina (p < 0.01), but development of congestive heart failure and survival were similar in both groups.
Conclusion:
These data suggest that young patients with AMI are very frequently heavy smokers, have a high incidence of angiographically normal coronary arteries, and that the short- and long-term prognosis is excellent.