Risk factors and coronary angiographic profile in young STEMI patients: results from a tertiary care centre in south-central India
Keywords:Coronary angiography, Diabetes, Dyslipidaemia, Smoking, ST-elevation myocardial infarction, Young
Background: Compared to older counterparts, a significant distinction has been found related to risk factors, clinical presentation, and prognosis of ST-segment elevation myocardial infarction (STEMI) in younger patients. To date, a lack of studies has been looked, specifically at-risk factors and angiographic profile of STEMI among younger patients; with this in mind, we conducted the present study.
Methods: This hospital-based, cross-sectional, open-label study was carried out at Deccan College of Medical Sciences between April 2018 and December 2019. Patients under 40 years with the presentation of STEMI were included. All patients were subjected to electrocardiography, 2D echocardiography, and coronary angiogram. Baseline demographics, risk factors, and procedural characteristics were recorded.
Results: Of 51 young STEMI patients, 41 (80.4%) were male and 10 (19.6%) were female. The most common risk factors associated with the development of STEMI in young patients were smoking (58.8%), followed by diabetes (45.1%), and dyslipidaemia (45.1%). Anterior wall MI was the most frequent presentation (84.3%). The left anterior descending artery was the most frequently (62.8%) involved vessel, followed by left circumflex artery (9.8%), and right coronary artery (5.9%).
Conclusions: Insights gained from the study can aid in identifying clinical characteristics of STEMI in young patients, which may be beneficial to achieve appropriate and timely management. Further, the young population should be educated as to control modifiable risk factors and smoking cessation to prevent coronary artery disease since they belong to the highly productive group in the community.
Department of Health. National Service Framework for Coronary Heart Disease. Avilable at: http://www.doh.gov.uk/publications. Accessed on 5 December 2020.
Kamili M, Dar I, Ali G, Wazir H, Hussain S. Prevalence of coronary heart disease in Kashmiris. Indian Heart J. 2007;59(1):44-9.
Kumar R, Singh MC, Ahlawat SK, Thakur JS, Srivastava A, Sharma MK, et al. Urbanization and coronary heart disease: a study of urban-rural differences in northern India. Indian Heart J. 2006;58(2):126-30.
Office of National Statistics. Weekly incidence of heart attacks. Avilable at: http://wwwstatisticsgovuk/morbidity/cardiovasculardiseases Acessed on 5 December 2020.
Fournier JA, Cabezón S, Cayuela A, Ballesteros SM, Cortacero JA, De La Llera LSD. Long-term prognosis of patients having acute myocardial infarction when ≤40 years of age. Am J Card. 2004;94(8):989-92.
Enas EA, Yusuf S, Mehta JL. Prevalence of coronary artery disease in Asian Indians. Am J Card. 1992;70(9):945-9.
Jneid H, Fonarow GC, Cannon CP, Hernandez AF, Palacios IF, Maree AO, et al. Clinical perspective. Circulation. 2008;118(25):2803-10.
Kanitz MG, Giovannucci SJ, Jones JS, Mott M. Myocardial infarction in young adults: risk factors and clinical features. Int J Emerg Med. 1996;14(2):139-45.
Rallidis LS, Politou M, Komporozos C, Panagiotakos DB, Belessi CI, Travlou A, et al. Factor XIII Val34Leu polymorphism and the risk of myocardial infarction under the age of 36 years. Thromb Haemost. 2008;99(06):1085-9.
Goliasch G, Wiesbauer F, Blessberger H, Maurer G, Derfler K, Speidl WS. Variation of lipoprotein (a) plasma levels after premature myocardial infarction. Int J Cardiol. 2015;186:5-6.
Milgrom A, Lee K, Rothschild M, Makadia F, Duhon G, Min S, et al. Thrombophilia in 153 patients with premature cardiovascular disease ≤ age 45. Clinical and Applied Thrombosis/Hemostasis. 2018;24(2):295-302.
Kato H, Inoue O, Toshima H, Kawasaki T, Fujiwara H, Watanabe T. Adult coronary artery disease probably due to childhood Kawasaki disease. The Lancet. 1992;340(8828):1127-9.
Yunyun W, Tong L, Yingwu L, Bojiang L, Yu W, Xiaomin H, et al. Analysis of risk factors of ST-segment elevation myocardial infarction in young patients. BMC Cardiovasc Disord. 2014;14(1):179.
Mammi M, Pavithran K, Abdu RP, Pisharody R, Sugathan K. Acute myocardial infarction in north Kerala--a 20 year hospital based study. Indian Heart J. 1991;43(2):93.
Ôunpuu S, Negassa A, Yusuf S. INTER-HEART: A global study of risk factors for acute myocardial infarction. Am Heart J. 2001;141(5):711-21.
Gupta R, Sharma K, Gupta A, Agrawal A, Mohan I, Gupta V, et al. Persistent high prevalence of cardiovascular risk factors in the urban middle class in India: Jaipur Heart Watch-5. J Assoc Physicians India. 2012;60(3):11-6.
Mukherjee D, Hsu A, Moliterno DJ, Lincoff AM, Goormastic M, Topol EJ. Risk factors for premature coronary artery disease and determinants of adverse outcomes after revascularization in patients≤ 40 years old. Am J Card. 2003;92(12):1465-7.
Aggarwal A, Aggarwal S, Goel A, Sharma V, Dwivedi S. A retrospective case-control study of modifiable risk factors and cutaneous markers in Indian patients with young coronary artery disease. JRSM cardiovascular disease. 2012;1(3):1-8.
Wiesbauer F, Blessberger H, Azar D, Goliasch G, Wagner O, Gerhold L, et al. Familial-combined hyperlipidaemia in very young myocardial infarction survivors (≤ 40 years of age). Eur Heart J. 2009;30(9):1073-9.
Hoit BD, Gilpin E, Henning H, Maisel A, Dittrich H, Carlisle J, et al. Myocardial infarction in young patients: an analysis by age subsets. Circulation. 1986;74(4):712-21.
Chan MY, Becker RC, Sim LL, Tan V, Lee CH, Low A, et al. Reperfusion strategy and mortality in ST-elevation myocardial infarction among patients with and without impaired renal function. Ann Acad Med Singapore. 2010;39(3):179-84.
Deepa M, Pradeepa R, Rima M, Mohan A, Deepa R, Shanthirani S, et al. The Chennai Urban Rural Epidemiology Study (CURES)-study design and methodology (urban component)(CURES-I). J Assoc Physicians India. 2003;51:863-70.
Mohan V, Deepa M, Farooq S, Prabhakaran D, Reddy K. Surveillance for risk factors of cardiovascular disease among an industrial population in southern India. Natl Med J India. 2008;21(1):8-13.
Aggarwal A, Srivastava S, Velmurugan M. Newer perspectives of coronary artery disease in young. World J Cardiol. 2016;8(12):728.
Christus T, Shukkur A, Rashdan I, Koshy T, Alanbaei M, Zubaid M, et al. Coronary artery disease in patients aged 35 or less–a different beast? Heart Views: The Official Journal of the Gulf Heart Association. 2011;12(1):7.
Bhardwaj R, Kandoria A, Sharma R. Myocardial infarction in young adults-risk factors and pattern of coronary artery involvement. Niger J Med. 2014;55(1):44.
Sánchez Calle J, de Mora Martín M, Hernández J, Guillén A, Malpartida F. Acute myocardial infarction in young adults. Analysis of risk factors and coronary angiography. Archivos del Instituto de Cardiologia de Mexico. 1991;61(3):225-9.
Chen L, Chester M, Kaski JC. Clinical factors and angiographic features associated with premature coronary artery disease. Chest. 1995;108(2):364-9.
Sinha SK, Krishna V, Thakur R, Kumar A, Mishra V, Jha MJ, et al. Acute myocardial infarction in very young adults: A clinical presentation, risk factors, hospital outcome index, and their angiographic characteristics in North India-AMIYA Study. Arya Atherosclerosis. 2017;13(2):79.
Entezarjou A, Mohammad MA, Andell P, Koul S. Culprit vessel: impact on short-term and long-term prognosis in patients with ST-elevation myocardial infarction. Open Heart. 2018;5(2):e000852.
Deshmukh PP, Singh MM, Deshpande MA, Rajput AS. Clinical and angiographic profile of very young adults presenting with first acute myocardial infarction: Data from a tertiary care center in Central India. Indian Heart J. 2019;71(5):418-21.