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OBJECTIVES: To assess characteristics of coronary arterial lesion (CAL) by means of invasive coronary angiography in young patients, aged <35 years, who sustained acute myocardial infarction (AMI).
METHODS: This prospective study of one-year duration was conducted from December 2009 to November 2010 at the cardiology departments of three teaching hospitals in Peshawar, Pakistan. All patients aged <35 years, evaluated angiographically after an AMI, were included. The individual CAL were characterized.
RESULTS: About 101 patients with AMI underwent coronary angiography. Mean age of the patients was 32.56±3.26 years (range 22–35 years). Out of 101 patients, 86 (78.18%) were males, while 15 (21.81%) were females. On coronary angiography, there were 25 (24.8%) patients with non-atherosclerotic coronary arteries, 39 (38.6%) with single vessel disease (SVD), 18 (17.8%) had double vessel disease (DVD), and 19 (18.8%) had triple vessel disease (TVD). Of the total, 3 patients (2.97%) had disease in the left main stem. One hundred thirty-two lesions (39x1=39 in SVD; 18x2=36 in DVD & 19x3=57 in TVD) were studied. The lesions were mostly discrete to tubular with less diffuse involvement and had either no or mild calcification. Thrombus was found in 5 patients with SVD (12.82%), 2 with DVD (11.11%) and 1 with TVD (1.75%).
CONCLUSION: This study shows that young (age <35 years) patients who have sustained AMI, have less extensive coronary artery disease but complex morphologic features. There was a higher incidence of normal vessels on coronary angiography with a very few cases of left main coronary arterial involvement.
KEY WORDS: Myocardial Infarction (MeSH); Coronary Artery Disease (MeSH); Coronary arterial lesions (Non-MeSH); Coronary Angiography (MeSH), Atherosclerosis (MeSH)
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1. Hong MK, Cho SY, Hong BK, Chang KJ, Mo-Chung I, Hyoung-Lee M, et al. Acute myocardial infarction in young adults. Yonsei Med J 1994;35(2):184–9. DOI: 10.3349/ymj.19188.8.131.52
2. Fournier JA, Cabezon S, Cayuela A, Ballesteros SM, Cortacero JA, Diaz De La Llera LS. Long-term prognosis of patients having acute myocardial infarction when <40 years of age. Am J Cardiol 2004;94(8):989–92. DOI: 10.1016/j.amjcard.2004.06.051
3. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case‑control study. Lancet 2004;364(9438):937‑52. DOI: 10.1016/S0140-6736(04)17018-9
4. Suresh G, Subramanyam K, Kudva S, Saya RP. Coronary artery disease in young adults: Angiographic study - A single center experience. Heart India 2016;4(4):132-5.
5. Egred M, Viswanathan G, Davis GK. Myocardial infarction in young adults. Postgrad Med J 2005; 81(962):741–5. DOI: 10.1136/pgmj.2004.027532
6. Bhatnagar D, Anand IS, Durrington PN, Patel DJ, Wander GS, Mackness MI, et al. Coronary risk factors in people from Indian sub-continent living in West London and their siblings in India. Lancet 1995; 345(8947):405–9.
7. Enas EA, Mehta J. Malignant coronary artery disease in young Asian Indians: thoughts on pathogenesis, prevention and treatment. Clin Cardiol 1995;18(3):131–5.
8. British Heart Foundation (BHF). BHF coronary heart disease statistics 2003. [Cited on: march 28, 2017] Available from URL: http:// www.bhf.org.uk/professionals/statistics
9. Ebbeling CB, Pawlak BB, Ludwig DS. Childhood obesity: public-health crisis, common sense cure. Lancet 2002; 360(9331):473–82. DOI: 10.1016/S0140-6736(02)09678-2
10. Horton R. Who pays in the obesity war? Lancet 2003;363(9406):339. DOI: 10.1016/S0140-6736(04)15469-X
11. Alizadehasl A, Sepasi F, Toufan M. Risk factors, Clinical manifestations and Outcome of Acute Myocardial Infarction in Young Patients. J Cardiovasc Thorac Res 2010;2 (1): 29-34.
12. Vivo RP, Krim SR. ST elevation myocardial infarction in a teenager: case report and review of the literature. South Med J 2009;102(5):523-6. DOI: 10.1097/SMJ.0b013e31819984fc.
13. Tamrakar R, Bhatt YD, Kansakar S, Bhattarai M, Shaha KB, Tuladhar E, et al. Acute Myocardial Infarction in Young Adults: Study of Risk factors, Angiographic Features and Clinical Outcome. Nepalese Heart J 2013;10(1):12-6.
14. Jeffery JP. Coronary arteriography and intravascular imaging. In: Braunwald E, Libby P, Bonow RO, Mann DL, Zipes D editors. Braunwald's heart disease: A textbook of cardiovascular medicine. 8th ed. Philadelphia, Pa: Saunders Elsevier; 2007: p.465-500.
15. Fournier JA, Sanchez A, Quero J, Fernandez-Cortacero JA, Gonzalez-Barrero A. Myocardial infarction in men aged 40 years or less; a prospective clinical-angiographic study. Clin Cardiol 1996;19(8):631-6.
16. Teng JK, Lin LJ, Tsai LM, KwanCM, Cheng JH. Acute myocardial infarction in young and very old Chinese adults: Clinical characteristics and therapeutic implications. Int J Cardiol 1994; 44(1):29-36.
17. Negus BH, Willard JE, Glamann DB, Landau C, Snyder RW 2nd, Hillis D, et al. Coronary anatomy and prognosis of young asymptomatic survivors of myocardial infarction. Am J Med l994;96(4):354-8.
18. Chen L, Chester M, Kaski JC. Clinical factors and angiographic features associated with premature coronary artery disease. Chest 1995;108(2):364-9.
19. Ryan TJ, Faxon DP, Gunnar RM, Kennedy JW, King SB 3rd, Loop FD, et al. Guidelines for percutaneous coronary angioplasty. A report of the American Heart Association/American College of Cardiology Task Force on Assessment of Diagnostic and Therapeutic Cardiovascular Procedures (Subcommittee on Percutaneous Transluminal Coronary Angioplasty). Circulation 1988;78(2):486-502.
20. Ellis SG, Vandormael MG, Cowley MJ, DiSciascio G, Deligonul U, Topol EJ, et al. Coronary morphologic and clinical determinants of procedural outcome with angioplasty for multivessel coronary disease. Implications for patient selection. Multivessel Angioplasty Prognosis Study Group. Circulation 1990;82(4):1193–202.
21. Tan K, Sulke N, Taub N, Sowton E. Clinical and lesion morphological determinants of coronary angioplasty success and complications: Current experience. J Am Coll Cardiol 1995;25(4):855-65. DOI: 10.1016/0735-1097(94)00462-Y
22. Rosen AD, Detre KM, Alderman E, Stadius M, Sopko G. How reliable is the assessment of coronary angiography? Circulation 1993;88(4):653
23. Botas J, Stadius ML, Bourassa MG, Rosen AD, Schaff HV, Sopko G, et al, and the BARI investigators: Angiographic correlates of lesion relevance and suitability for percutaneous transluminal coronary angioplasty and coronary artery bypass grafting in the Bypass Angioplasty Revascularization Investigation study (BARI). Am J Cardiol 1996;77(10):805-14.
24. Krone RJ, Laskey WK, Johnson C, Kimmel SE, Klein LW, Weiner BH, et al. A simplified lesion classification for predicting success and complications of coronary angioplasty. Registry Committee of the Society for Cardiac Angiography and Interventions. Am J Cardiol 2000;85(10):1179-84.
25. Krone RJ, Kimmel SE, Laskey WK, Klein LW, Schechtman KB, Cosentino JJ, et al. Evaluation of the Society for Coronary Angiography and Interventions’ lesion classification system in 14,133 patients with percutaneous coronary interventions in the current stent era. Catheter Cardiovasc Interv 2002; 55(1):1-7.
26. Krone RJ, Shaw RE, Klein LW, Block PC, Anderson HV, Weintraub WS, et al. Evaluation of the American College of Cardiology/ American Heart Association and the Society for Coronary Angiography and Interventions Lesion Classification System in the Current “Stent Era” of Coronary Interventions (from the ACC-National Cardiovascular Data Registry). Am J Cardiol 2003;92(4):389-94.
27. Krone RJ, Shaw RE, Anderson HV, Block PC, Brindis RG, on behalf of the ACC-NCDR. Outcome of PCI with stenting is independent of lesion classification, but lesion classification by the ACC or SCAI system assumes great importance if a stent is not used. A report from the ACC-National Cardiovascular Data Registry (ACC-NCDR). J Am Coll Cardiol 2002; 39:1096-103.
28. Klein LW, Agarwal JB, Herlich MB, Leary TM, Helfant RH. Prognosis of symptomatic coronary artery disease in young adults aged 40 years or less. Am J Cardiol 1987;60(16):1269-72.
29. Kanitz MG, Giovannucci SI, Jones JS, Mott M. Myocardial infarction in young adults: Risk factors and clinical features. J Emerg Med 1996; 14(2):139-45.
30. Shah SS, Noor L, Shah SH, Sawar S, Din SU, Awan ZA, et al. Myocardial infarction in young versus older adults: clinical characteristics and angiographic features. J Ayub Med Coll Abbottabad 2010;22(2):187-90.