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- Title
Acute Myocardial Infarction in Youngs: Presentation, Treatment and Outcome.
- Authors
Andronescu, Anna-Maria; Nechita, A.; Panaitescu, Eugenia; Vintilă, M.; Dorobanţu, Maria
- Abstract
Objectives: Few data regarding acute myocardial infarction (AMI) in young Romanian adults are published. The present study aims to identify the clinical, biological, imagistic, therapeutic profile and the inhospital and mid-term outcomes of the myocardial infarction in a Romanian population younger than 45 years. Methods: The studied population consisted of 173 Romanian adults (mean age 39 ± 5 years, range 19 to 45 years) admitted for AMI in two acute cardiac care units between January 2009 and December 2011. The baseline characteristics, procedures and treatment were collected at the time of the index event. The patients were followed-up for up to 4 years (mean 3 ± 1 years). The primary endpoint was a composite of major adverse cardiac events (MACE): cardiovascular death, new myocardial infarction, subsequent revascularization and emergency cardiac readmissions. Results: The majority of patients were male (91.3%). Smoking (90.8%), dyslipidemia (64.7%) and hypertension (41%) were the most prevalent risk factors and in 2.9% of patients no apparent risk factor was identified. ST-elevation acute myocardial infarction (STEMI) was diagnosed in 80.3% of patients and 19.7% had a non-ST elevation acute myocardial infarction (NSTEMI). Almost 2/3 of the STEMI patients (71.9%) received reperfusion therapy: primary angioplasty (PTCA) in 43.9% of cases, thrombolysis (23.7%) and facilitated PTCA in 4.3% of patients. The median "symptom onset-to-needle" time was 168 (120-225) minutes while median "symptom onset-to-balloon" time was 310 (210-540) minutes (p<0.01). Obstructive coronary artery disease was diagnosed in 90.3% of the patients who underwent coronary angiography: single vessel disease in 58.3% and significant multivessel stenosis in 31.9% of patients. Mean left ventricle ejection fraction at discharge was 49 ± 11%. The most frequent acute complications were: heart failure in 15%, recurrent ischaemia in 12.1%, and arrhythmias in 10.4% of patients. The in-hospital mortality was 3.5% (6 deaths). The long term outcome in this cohort of young patients was poor: 33.8% of 142 followed-up patients had at least 1 recurrent MACE after the initial AMI. Conclusion: The young Romanian patients with AMI have a high atherosclerotic burden. Even though they benefit in a large proportion of timely reperfusion therapy and the survival rate is high, the long term outcome is impaired by major cardiovascular complications in 1 of 3 young patients with AMI. Focused research on the factors that influence the outcome and targeted interventions are needed in this distinct and vulnerable subgroup of AMI patients.
- Subjects
MYOCARDIAL infarction; CARDIOVASCULAR diseases; DISEASES in youths
- Publication
Medicina Moderna, 2018, Vol 25, Issue 3, p252
- ISSN
1223-0472
- Publication type
Article