Chest
Volume 94, Issue 5, November 1988, Pages 926-930
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Clinical Investigations
Myocardial Infarction in the Young: Angiographic Features and Risk Factor Analysis of Patients with Myocardial Infarction at or before the Age of 35 Years

https://doi.org/10.1378/chest.94.5.926Get rights and content

We reviewed the records of 2,400 consecutive patients undergoing cardiac catheterization at USAF Medical Center Keesler between 1978 and 1984 and found 35 patients (1.5 percent of all cardiac catheterizations) aged 35 years or less (mean age, 32 years) who underwent cardiac catheterization after myocardial infarction. These 35 patients (group 1) were compared to a randomly selected group of 100 patients (group 2) aged 55 years or greater who underwent cardiac catheterization for evaluation of coronary artery disease during the same period. The two groups were compared in terms of angiographic features and risk factors for coronary artery disease. The patients in group 1 had a higher proportion of normal coronary arteries (14 percent [5 patients] vs 0; p<0.01) and single-vessel disease compared to group 2, while the incidence of three-vessel disease was much less (14 percent [5] vs 47 percent; p<0.001). Involvement of the left main coronary artery was uncommon in group 1 (3 percent [1] vs 15 percent in group 2; p<0.01). Risk factor analysis revealed smoking to be the most common risk factor in both groups (89 percent [31] in group 1 and 91 percent in group 2). Hypertension (28 percent [10] vs 48 percent; p<0.05) and diabetes (3 percent [1] vs 23 percent; p<0.01) were more common in group 2. Importantly, of 19 patients in group 1 who underwent cardiac catheterization for prognosis despite being asymptomatic and able to reach at least stage 4 on a Bruce protocol exercise test, none was found to have residual surgically correctable disease.

Section snippets

MATERIALS AND METHODS

We reviewed all cardiac catheterization and in-patient hospital records of the first 2,400 consecutive patients undergoing this procedure at Keesler Medical Center between 1978 and 1984. Of those 2,400 patients, 35 patients at or under the age of 35 years (active-duty military personnel) had been catheterized for evaluation after myocardial infarction (during this same period, 28 patients 35 years old or younger were catheterized for evaluation of chest pain not due to myocardial infarction

RESULTS

Of the 35 patients aged 35 years or less (group 1), 31 were men, and four were women. There were seven black and 28 white patients. The mean age was 31.9 years. The mean age of patients over 55 years (group 2) was 61 years, with 87 men and 13 women; 98 were white patients, and two were black. Although the sex distribution was not significantly different between the two groups, the percentage of black patients suffering myocardial infarction was significantly greater in young patients (Table 1).

DISCUSSION

The distribution of lesions in our patients, with a high incidence of normal coronary arteries and single-vessel disease, is in accordance with previous studies,1, 2, 3, 4, 5, 6 as is the paucity of patients with left main coronary artery disease.

Smoking by far was the most common risk factor in young and old patients in our study, and our incidence of 89 percent (31) in the young patients correlates with previously reported data, which ranges from 80 to 86 percent.7, 8, 9 Smoking has been

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    2019, Trends in Cardiovascular Medicine
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    Given that young patients with ACS presented an average of two decades earlier than old patients and with fewer risk factors, it is conceivable that researchers observed less multivessel disease, less calcification, and fewer ostial lesions in young people compared with old people [1,11]. There was a predilection for the presence of significant coronary artery disease (CAD) in the left anterior descending artery in the young group, as previously documented [28,29]. Interestingly, the proportion of nonobstructive CAD in the clinical setting of ACS was similar in the young women and men (15% versus 10%), but the mortality rate was higher in women [11].

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The ideas and opinions expressed in this article are those of the authors and not necessarily those of the United States Air Force.

Manuscript received January 18; revision accepted April 12.

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