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Research ArticleOriginal Article
Open Access

Clinical profiles and outcomes of acute ST-segment elevation myocardial infarction in young adults in a tertiary care center in Saudi Arabia

Haitham Sakr, Ahmed S. Azazy, Ali Hillani, Mohamed Ebada, Abdulrahman Alharbi, Saleh Alshalash, Rami Abazid and Abdulrahman Algassim
Saudi Medical Journal November 2021, 42 (11) 1201-1208; DOI: https://doi.org/10.15537/smj.2021.42.11.20210412
Haitham Sakr
From the Department of Cardiology (Sakr, Azazy, Hillani, Ebada, Alharbi, Algassim) King Saud Medical City; from the Department of Medicine (Algassim), King Saud Medical City; from the Department of Cardiology (Sakr), King Abdullah Bin Abdulaziz University Hospital; from the Department of Cardiology (Alshalash), King Fahad Medical City; form the Department of Medicine (Algassim), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia; from the Department of Cardiology (Hillani), University of Montreal Hospital Center, Montreal, Quebec; and from the Division of Nuclear Medicine (Abazid), London Health Sciences Centre, University Hospital, London, Ontario, Canada.
MD, FRCP
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Ahmed S. Azazy
From the Department of Cardiology (Sakr, Azazy, Hillani, Ebada, Alharbi, Algassim) King Saud Medical City; from the Department of Medicine (Algassim), King Saud Medical City; from the Department of Cardiology (Sakr), King Abdullah Bin Abdulaziz University Hospital; from the Department of Cardiology (Alshalash), King Fahad Medical City; form the Department of Medicine (Algassim), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia; from the Department of Cardiology (Hillani), University of Montreal Hospital Center, Montreal, Quebec; and from the Division of Nuclear Medicine (Abazid), London Health Sciences Centre, University Hospital, London, Ontario, Canada.
MD, MSc
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Ali Hillani
From the Department of Cardiology (Sakr, Azazy, Hillani, Ebada, Alharbi, Algassim) King Saud Medical City; from the Department of Medicine (Algassim), King Saud Medical City; from the Department of Cardiology (Sakr), King Abdullah Bin Abdulaziz University Hospital; from the Department of Cardiology (Alshalash), King Fahad Medical City; form the Department of Medicine (Algassim), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia; from the Department of Cardiology (Hillani), University of Montreal Hospital Center, Montreal, Quebec; and from the Division of Nuclear Medicine (Abazid), London Health Sciences Centre, University Hospital, London, Ontario, Canada.
MD
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Mohamed Ebada
From the Department of Cardiology (Sakr, Azazy, Hillani, Ebada, Alharbi, Algassim) King Saud Medical City; from the Department of Medicine (Algassim), King Saud Medical City; from the Department of Cardiology (Sakr), King Abdullah Bin Abdulaziz University Hospital; from the Department of Cardiology (Alshalash), King Fahad Medical City; form the Department of Medicine (Algassim), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia; from the Department of Cardiology (Hillani), University of Montreal Hospital Center, Montreal, Quebec; and from the Division of Nuclear Medicine (Abazid), London Health Sciences Centre, University Hospital, London, Ontario, Canada.
MD, MSc
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Abdulrahman Alharbi
From the Department of Cardiology (Sakr, Azazy, Hillani, Ebada, Alharbi, Algassim) King Saud Medical City; from the Department of Medicine (Algassim), King Saud Medical City; from the Department of Cardiology (Sakr), King Abdullah Bin Abdulaziz University Hospital; from the Department of Cardiology (Alshalash), King Fahad Medical City; form the Department of Medicine (Algassim), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia; from the Department of Cardiology (Hillani), University of Montreal Hospital Center, Montreal, Quebec; and from the Division of Nuclear Medicine (Abazid), London Health Sciences Centre, University Hospital, London, Ontario, Canada.
MD
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Saleh Alshalash
From the Department of Cardiology (Sakr, Azazy, Hillani, Ebada, Alharbi, Algassim) King Saud Medical City; from the Department of Medicine (Algassim), King Saud Medical City; from the Department of Cardiology (Sakr), King Abdullah Bin Abdulaziz University Hospital; from the Department of Cardiology (Alshalash), King Fahad Medical City; form the Department of Medicine (Algassim), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia; from the Department of Cardiology (Hillani), University of Montreal Hospital Center, Montreal, Quebec; and from the Division of Nuclear Medicine (Abazid), London Health Sciences Centre, University Hospital, London, Ontario, Canada.
MD, FRCPC
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Rami Abazid
From the Department of Cardiology (Sakr, Azazy, Hillani, Ebada, Alharbi, Algassim) King Saud Medical City; from the Department of Medicine (Algassim), King Saud Medical City; from the Department of Cardiology (Sakr), King Abdullah Bin Abdulaziz University Hospital; from the Department of Cardiology (Alshalash), King Fahad Medical City; form the Department of Medicine (Algassim), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia; from the Department of Cardiology (Hillani), University of Montreal Hospital Center, Montreal, Quebec; and from the Division of Nuclear Medicine (Abazid), London Health Sciences Centre, University Hospital, London, Ontario, Canada.
MD, FSCCT
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Abdulrahman Algassim
From the Department of Cardiology (Sakr, Azazy, Hillani, Ebada, Alharbi, Algassim) King Saud Medical City; from the Department of Medicine (Algassim), King Saud Medical City; from the Department of Cardiology (Sakr), King Abdullah Bin Abdulaziz University Hospital; from the Department of Cardiology (Alshalash), King Fahad Medical City; form the Department of Medicine (Algassim), Prince Sultan Military Medical City, Riyadh, Kingdom of Saudi Arabia; from the Department of Cardiology (Hillani), University of Montreal Hospital Center, Montreal, Quebec; and from the Division of Nuclear Medicine (Abazid), London Health Sciences Centre, University Hospital, London, Ontario, Canada.
MD, MSc
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  • For correspondence: [email protected]
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    Figure 1

    - Laboratory results for patients younger and older than 45 years. A) Mean white blood cell count (WBC) among patients younger than 45 years of age in comparison to that among patients aged 45 years or older at presentation. B-C) Mean neutrophil and lymphocytic count in patients younger and older than 45 years at presentation B) Mean hemoglobin (Hgb) level among patients younger than 45 years in comparison to that among patients aged 45 years or older. E) Mean creatinine level in patients younger than 45 years in comparison to that among patients aged 45 years or older. F-H) The cardiac markers creatine kinase (CK), creatine kinase-MB (CK-MB), and troponin among patients younger than 45 years in comparison to that among patients aged 45 years or older. *p<0.05, **p<0.01, and error bars represent the 95% confidence interval.

  • Figure 2
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    Figure 2

    - Lipid profile and length of hospital stay for patients younger and older than 45 years. A-B) Mean low-density lipoprotein cholesterol (LDL) and total cholesterol in the two populations. C) Mean duration of hospital stay (in days) in patients younger and older than 45 years. *p<0.05, and error bars represent the 95% confidence interval. Hosp: hospital, Chol: cholesterol

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    Table 1

    - Baseline demographic and clinical characteristics of patients younger and older than 45 years.

    VariableYounger than 4545 or olderP-value
    (n=197)(n=205)
    Age (years), mean ± SD (range)40±4 (26-45)55±7 (46-95)0.001
    Gender   
    Female5 (2.5)6 (3.0)0.81
    Male192 (97.5)199 (97.0)
    History of hypertension50 (25.0)75 (36.0)0.01
    History of diabetes mellitus80 (40.0)108 (52.0)0.01
    History of dyslipidemia31 (16.0)49 (24.0)0.04
    Newly diagnosed dyslipidemia89 (44.0)67 (32.0)0.01
    Total dyslipidemia120 (60.0)116 (56.0)0.4
    Obesity15 (7.0)39 (19.0)0.001
    Smoking107 (52.0)91 (35.0)0.001
    Substance abuse6 (3.0)1 (0.5)0.06
    Family history of AMI5 (2.5)1 (0.5)0.12
    History of AMI12 (6.0)25 (12.0)0.03
    History of CABG02 (1.0)0.5
    History of PCI10 (5.0)16 (8.0)0.27
    History of stroke/TIA03 (1.5)0.25
    History of COPD2 (1.0)4 (2.0)0.69
    History of CKD2 (1.0)5 (2.5)0.45
    • Values are presented as numbers and percentages (%). CABG: coronary artery bypass graft, CKD: chronic kidney disease, COPD: chronic obstructive pulmonary disease, PCI: percutaneous coronary intervention, TIA: transient ischemic attack, STEMI: ST-segment elevation myocardial infarction, AMI: acute myocardial infarction, SD: standard deviation

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    Table 2

    - Clinical presentation and outcomes of patients younger and older than 45 years.

    VariableLess than 45 (n=197)45 or more (n=205)P-value
    HR/min, mean±SD (range)88±19 (43-173)88 ± 20 (40-180)0.62
    SBP (mm Hg), mean±SD (range)133±25 (84-229)135 ± 25 (83-232)0.28
    DBP (mm Hg), mean±SD (range)86±17 (45-143)86 ± 16 (39-130)0.89
    SPO2, mean±SD (range)97% ± 3 (69-100)96% ± 4 (65-100)0.02
    Atypical presentation1 (0.50)2 (0.97)0.58
    Symptoms to door time, mean±SD (range)9 ± 19 (0.5-168)12 ± 28 (0.5-240)0.22
    Type
    STEMI159 (81.0)159 (77.0)0.44
    Late STEMI38 (19.0)46 (23.0)
    Time of incidence
    00 to 0640 (20.0)48 (23.0)0.52
    06 to 1253 (27.0)64 (31.0)
    12 to 1857 (29.0)52 (25.0)
    18 to 0047 (24.0)41 (20.0)
    Arrest
    Pre-hospital1 (0.5)1 (0.5)0.98
    In-hospital4 (2.0)2 (1.0)0.38
    Killip class
    I/II193 (97.0)183 (90.0)0.002 0.56
    III/IV5 (3.0)21 (10.0)
    Cardiogenic shock4 (2.0)6 (3.0)
    Arrhythmias
    AF3 (1.5)2 (1.0)0.62
    Other arrhythmias8 (4.0)10 (5.0)0.69
    Anterior wall MI96 (49.0)113 (55.0)0.2
    Non-anterior wall MI101 (51.0)92 (45.0)
    Ejection fraction
    <35%47 (24.0)62 (30.0)0.15
    >35%150 (76.0)143 (70.0)
    Thrombolysis32 (16.0)38 (18.0)0.27
    Invasive strategy130 (66.0)106 (52.0)0.004
    CABG referral1 (0.50)5 (2.5)0.12
    In-hospital MACE
    Death3 (1.5)6 (2.9)0.49
    Stroke (TIA)2 (1.0)2 (1.0)0.97
    AKI1 (0.5)4 (2.0)0.19
    • Values are presented as numbers and percentages (%). AF: atrial fibrillation, AKI: acute kidney injury, DBP: diastolic blood pressure, HR: heart rate, MI: myocardial infarction, SBP: systolic blood pressure, SPO2: oxygen saturation, SD: standard deviation, MACE: major adverse cardiovascular events

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Saudi Medical Journal: 42 (11)
Saudi Medical Journal
Vol. 42, Issue 11
1 Nov 2021
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Clinical profiles and outcomes of acute ST-segment elevation myocardial infarction in young adults in a tertiary care center in Saudi Arabia
Haitham Sakr, Ahmed S. Azazy, Ali Hillani, Mohamed Ebada, Abdulrahman Alharbi, Saleh Alshalash, Rami Abazid, Abdulrahman Algassim
Saudi Medical Journal Nov 2021, 42 (11) 1201-1208; DOI: 10.15537/smj.2021.42.11.20210412

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Clinical profiles and outcomes of acute ST-segment elevation myocardial infarction in young adults in a tertiary care center in Saudi Arabia
Haitham Sakr, Ahmed S. Azazy, Ali Hillani, Mohamed Ebada, Abdulrahman Alharbi, Saleh Alshalash, Rami Abazid, Abdulrahman Algassim
Saudi Medical Journal Nov 2021, 42 (11) 1201-1208; DOI: 10.15537/smj.2021.42.11.20210412
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Keywords

  • ST elevation myocardial infarction
  • dyslipidemias
  • smoking
  • young adult
  • Saudi Arabia

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