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Normal angiogram after myocardial infarction in young patients: a prospective clinical-angiographic and long-term
J A Fournier1, A Sánchez-González, J Quero
1Servicio de Cardiologia, Hospital Universitario Virgen del Rocio, Seville, Spain.
Insights
Young patients experiencing acute myocardial infarction (heart attack) have a good long-term prognosis regardless of coronary artery disease. Those with normal coronary arteries faced fewer risk factors and new ischemic events.
Area of Science:
- Cardiology
- Internal Medicine
- Clinical Research
Background:
- Young patients (< or = 40 years) experiencing acute myocardial infarction (AMI) present a unique clinical challenge.
- Understanding the long-term outcomes and risk factors associated with AMI in this demographic is crucial for effective management.
- Coronary artery anatomy in young AMI patients can vary, necessitating a comparison between those with normal arteries and those with significant coronary artery disease (CAD).
Purpose of the Study:
- To compare the clinical characteristics and long-term prognosis of young patients with AMI and angiographically normal coronary arteries versus those with significant CAD.
- To identify differences in risk factors, clinical presentation, and ventricular function between these two groups.
- To evaluate the occurrence of major adverse cardiac events, including death and recurrent myocardial infarction, over a follow-up period.
Main Methods:
- An observational, prospective study involving 87 patients aged 40 years or younger who suffered an AMI.
- Coronary angiography was performed within one month of admission to assess coronary artery anatomy.
- Patients were divided into two groups: Group 1 (normal coronary arteries, n=12) and Group 2 (significant CAD, n=75).
- Clinical data, risk factors, ventricular function, and long-term outcomes were compared between the groups.
Main Results:
- Patients with normal coronary arteries (Group 1) had significantly fewer risk factors (e.g., hypertension, hypercholesterolemia), were younger, and were less frequent heavy smokers compared to Group 2.
- Group 1 patients experienced AMI onset more commonly during heavy physical exertion.
- Over a mean follow-up of 41 months, no deaths or recurrent AMIs occurred in Group 1, whereas 4 deaths were recorded in Group 2. Angina incidence was lower in Group 1.
Conclusions:
- Young patients with AMI exhibit a favorable long-term prognosis irrespective of coronary artery anatomy.
- Patients with normal coronary arteries and AMI tend to have fewer cardiovascular risk factors and a lower incidence of new ischemic events.
- The findings suggest that while AMI in young individuals generally has a good outcome, risk factor modification remains important, particularly for those with underlying coronary artery disease.
Abstract:
This is an observational study in which we compared the clinical characteristics and the long-term course of young patients having acute myocardial infarction and angiographically normal coronary arteries and young patients showing significant coronary artery disease. In 87 patients aged < or = 40 years who suffered an acute myocardial infarction, enrolled in a prospective study over a period of 6.5 years, coronary anatomy was determined by angiography within a month of admission. The risk factors, clinical data, ventricular function and the long-term outcome were compared between patients with normal angiograms (Group 1, n = 12) and patients with coronary artery disease (Group 2, n = 75). Patients in Group 1 had a lower number of risk factors associated with them (17% vs. 64% with > 1 risk factor, P < 0.005), were younger (32 +/- 5 vs. 36 +/- 4, P < 0.01), lighter smokers (25% vs. 55% for > or = 2 packs per day, P < 0.05), had less frequent hypertension (0 vs. 25%, P < 0.05), hypercholesterolemia (17% vs. 52%, P = 0.02) and had a lower mean total cholesterol level (201 +/- 42 vs. 245 +/- 60 mg/100 ml, P < 0.05) than patients in Group 2. They also had a more common onset of their infarction during heavy physical exertion (67% vs. 17%, P < 0.001). A history of previous myocardial infarction, infarct location, global left ventricular function and regional wall motion were similar in both groups. After a mean follow-up period of 41 +/- 23 months, no patient died or had a second myocardial infarction in Group 1, and 4 patients had died in Group 2. The appearance of angina, less frequent in Group 1 than Group 2, tended to correlate with the extension of the coronary artery disease. We concluded that young patients with myocardial infarction have good prognosis irrespective of the coronary anatomy, although patients with normal coronary angiograms had less risk factors and less frequent new ischaemic events.