Clinical and angiographic characteristics of young adult patients recovered from acute myocardial infarction

• Main Author: Miljković Dušan
• Format: Article
• Language: English
• Published: Serbian Medical Society, Belgrade 2015-01-01
• Series: Opšta Medicina
• Subjects: myocardial infarction; young adults; coronary angiography; coronary risk factors
• Online Access: https://scindeks-clanci.ceon.rs/data/pdf/0354-7132/2015/0354-71321504091M.pdf
• ISSN: 0354-7132; 2217-3994

Introduction. Occurrence of acute myocardial infarction in young adults is a relatively rare. In majority of the studies, age of 45 years is used as cut-off line in definition of the young patients with coronary artery disease or myocardial infarction. Studies have shown that younger population aged less than 40 years represents only 2-8% of all patients with myocardial infarction. Objective. The aim of this study was to examine the specificities of clinical and angiographic characteristics of the patients recovered from acute myocardial infarction, younger than 45 years at the moment of attack, by comparing their clinical and angiographic characteristics with those of patients older than 65 years, who recovered from acute myocardial infarction. Method. The study included 78 patients recovered from acute myocardial infarction, 33 patients were younger than 45 years (40.7 ± 3.9 years), 25 (75.7%) men and eight (24.2%) female, and 45 patients were older than 65 years (68.2 ± 4.2 years), 32 (71.3%) men and 13 women. Detailed history taking, physical examination, permanent ECG monitoring, laboratory analyses, X-ray examination, echocardiography and selective coronarography of all patients were performed. Results. Patients younger than 45 years had a significantly higher incidence of STEMI (p <0.01), lower infarction (p<0.01) and diaphragmatic infarction (p <0.01) compared to patients older than 65 years, and patients older than 65 years had anterior infarction more frequent (p<0.01). Three vessel coronary disease had 18.2% of patients younger than 45 and 57.8% older than 65 years (p<0.01), two vessel disease had 36.4% vs. 20.0% (p <0.05) and one vessel disease had 36.4% vs. 20.0% (p>0.05) Multivessel disease existed at 54.5% under the age of 45 and 77.8% older than 65 years (p<0.05). Among patients with one vessel coronary disease. Stenosis of LAD was found in 63.6% of patients under 45 years, and in 84.4% of patients over 65 years (p<0.05), stenosis of RCX in 39.4% vs. 62.2% (p<0.05) and stenosis of RCA in 57.6% vs. 68.9% (p>0.05). The disease of left main coronary artery had 6.1% of patients younger than 45 and 22.2% of patients older than 65 years (p<0.05). 9.1% of patients younger than 45 and 2.2% of patients older than 65 years (p>0.05) Were without significant coronary artery stenosis Comparing risk factors for coronary artery disease in patients younger than 45 years and older than 65 years, we find: hypertension in 48.5% vs. 88.9% (p<0.01), hyperlipidemia in 69.69% vs. 71.1% (p>0.05), diabetes mellitus in 21.2% vs. 55.5% (p <0.01), smoking in 72.7% vs. 33.3% (p<0.01), obesity in 33.3% vs. 33.3% (p>0.05), and stress in 18.2% vs. 2.2% (p <0.01). Conclusion. Patients with myocardial infarction younger than 45 years are predominantly male and have a significantly higher incidence of infarction with ST segment elevation (STEMI), lower and diaphragmatic localization of infarction, significantly higher prevalence of smoking habits, hypertriglyceridemia and stress, as well as significantly lower incidence of three-vessel and multivessel disease and stenosis of the left main coronary artery, compared to patients with myocardial infarction older than 65 years.