Characteristics and Long-Term Prognosis of Patients ≤35 Years of Age with ST-Segment Elevation Myocardial Infarction and “Normal or Near Normal” Coronary Arteries

Abstract There are scarce data regarding the risk factor profile and prognosis of patients with premature ST-segment elevation myocardial infarction (STEMI) and “normal or near normal” coronary arteries (N/NNCAs). We compared the characteristics and long-term prognosis of patients with premature STE...

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Published in:The American journal of cardiology 2017-09, Vol.120 (5), p.740-746
Main Authors: Rallidis, Loukianos S, MD, Gialeraki, Argyri, PhD, Triantafyllis, Andreas S, MD, Tsirebolos, Georgios, MD, Liakos, Georgios, PhD, Moutsatsou, Paraskevi, MD, Iliodromitis, Efstathios, MD
Format: Article
Language:English
Subjects:
Abnormalities
Acute coronary syndromes
Adult
Age
Angiography
Arteries
Atherosclerosis
Cardiovascular
Cardiovascular disease
Cardiovascular diseases
Cause of Death - trends
Cholesterol
Confidence intervals
Coronary Angiography - methods
Coronary artery
Coronary artery disease
Coronary vessels
Coronary Vessels - diagnostic imaging
Diabetes
Electrocardiography
Female
Follow-Up Studies
Greece - epidemiology
Health risk assessment
Heart
Heart attacks
Heart diseases
Homocysteine
Hospitalization
Humans
Hypertension
Lesions
Male
Medical imaging
Medical prognosis
Methylenetetrahydrofolate reductase
Myocardial infarction
Patients
Polymorphism
Prognosis
Reduction
Reperfusion
Risk analysis
Risk factors
Smoking
ST Elevation Myocardial Infarction - diagnosis
ST Elevation Myocardial Infarction - mortality
Stents
Survival Rate - trends
Thrombosis
Time Factors
Ventricle
Vitamin B
Working groups
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creator Rallidis, Loukianos S, MD
Gialeraki, Argyri, PhD
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Moutsatsou, Paraskevi, MD
Iliodromitis, Efstathios, MD
description Abstract There are scarce data regarding the risk factor profile and prognosis of patients with premature ST-segment elevation myocardial infarction (STEMI) and “normal or near normal” coronary arteries (N/NNCAs). We compared the characteristics and long-term prognosis of patients with premature STEMI and N/NNCAs to their counterparts with significant coronary artery disease (CAD). We recruited 330 patients who had STEMI ≤35 years of age and 167 age and sex-matched controls. All patients underwent coronary angiography. Coronary arteries with no lesions or lesions causing
doi_str_mv 10.1016/j.amjcard.2017.06.002
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We compared the characteristics and long-term prognosis of patients with premature STEMI and N/NNCAs to their counterparts with significant coronary artery disease (CAD). We recruited 330 patients who had STEMI ≤35 years of age and 167 age and sex-matched controls. All patients underwent coronary angiography. Coronary arteries with no lesions or lesions causing &lt;30% reduction in lumen diameter were defined as N/NNCAs while narrowings causing ≥50% diameter reduction formed the significant CAD group. Lipid profile, homocysteine levels and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism were determined. Sixty patients (18%) had N/NNCAs. Patients with N/NNCAs had a more favourable lipid profile, i.e., lower low-density lipoprotein-cholesterol and higher high-density lipoprotein-cholesterol levels, higher homocysteine levels and higher prevalence of MTHFR TT genotype (34.6 vs 18%, p=0.008) compared to patients with significant CAD. After a median follow-up of 8 years, cardiovascular events occurred in 105 (36%) of 291 patients with available follow-up data. Significant CAD was associated with higher risk for recurrent cardiovascular events after adjustment for traditional risk factors (hazard ratio [HR] 2.095, 95% confidence interval [CI] 1.088-3.664, p=0.022) and additional adjustment for left ventricular ejection fraction, reperfusion therapy and persistent smoking (HR 1.869, 95% CI 1.007-3.468, p=0.041). In conclusion, patients with premature STEMI and N/NNCAs have fewer lipid abnormalities, higher homocysteine levels and prevalence of MTHFR TT genotype and better long-term prognosis compared to their counterparts with significant CAD.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2017.06.002</identifier><identifier>PMID: 28689750</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Abnormalities ; Acute coronary syndromes ; Adult ; Age ; Angiography ; Arteries ; Atherosclerosis ; Cardiovascular ; Cardiovascular disease ; Cardiovascular diseases ; Cause of Death - trends ; Cholesterol ; Confidence intervals ; Coronary Angiography - methods ; Coronary artery ; Coronary artery disease ; Coronary vessels ; Coronary Vessels - diagnostic imaging ; Diabetes ; Electrocardiography ; Female ; Follow-Up Studies ; Greece - epidemiology ; Health risk assessment ; Heart ; Heart attacks ; Heart diseases ; Homocysteine ; Hospitalization ; Humans ; Hypertension ; Lesions ; Male ; Medical imaging ; Medical prognosis ; Methylenetetrahydrofolate reductase ; Myocardial infarction ; Patients ; Polymorphism ; Prognosis ; Reduction ; Reperfusion ; Risk analysis ; Risk factors ; Smoking ; ST Elevation Myocardial Infarction - diagnosis ; ST Elevation Myocardial Infarction - mortality ; Stents ; Survival Rate - trends ; Thrombosis ; Time Factors ; Ventricle ; Vitamin B ; Working groups</subject><ispartof>The American journal of cardiology, 2017-09, Vol.120 (5), p.740-746</ispartof><rights>Elsevier Inc.</rights><rights>2017 Elsevier Inc.</rights><rights>Copyright © 2017 Elsevier Inc. All rights reserved.</rights><rights>Copyright Elsevier Sequoia S.A. 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We compared the characteristics and long-term prognosis of patients with premature STEMI and N/NNCAs to their counterparts with significant coronary artery disease (CAD). We recruited 330 patients who had STEMI ≤35 years of age and 167 age and sex-matched controls. All patients underwent coronary angiography. Coronary arteries with no lesions or lesions causing &lt;30% reduction in lumen diameter were defined as N/NNCAs while narrowings causing ≥50% diameter reduction formed the significant CAD group. Lipid profile, homocysteine levels and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism were determined. Sixty patients (18%) had N/NNCAs. Patients with N/NNCAs had a more favourable lipid profile, i.e., lower low-density lipoprotein-cholesterol and higher high-density lipoprotein-cholesterol levels, higher homocysteine levels and higher prevalence of MTHFR TT genotype (34.6 vs 18%, p=0.008) compared to patients with significant CAD. After a median follow-up of 8 years, cardiovascular events occurred in 105 (36%) of 291 patients with available follow-up data. Significant CAD was associated with higher risk for recurrent cardiovascular events after adjustment for traditional risk factors (hazard ratio [HR] 2.095, 95% confidence interval [CI] 1.088-3.664, p=0.022) and additional adjustment for left ventricular ejection fraction, reperfusion therapy and persistent smoking (HR 1.869, 95% CI 1.007-3.468, p=0.041). 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Gialeraki, Argyri, PhD ; Triantafyllis, Andreas S, MD ; Tsirebolos, Georgios, MD ; Liakos, Georgios, PhD ; Moutsatsou, Paraskevi, MD ; Iliodromitis, Efstathios, MD</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c448t-4dc31cfe57e669a0de9c8093e3e2d8a560f0fa404ad2658f8d74599974f3fd0f3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2017</creationdate><topic>Abnormalities</topic><topic>Acute coronary syndromes</topic><topic>Adult</topic><topic>Age</topic><topic>Angiography</topic><topic>Arteries</topic><topic>Atherosclerosis</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Cardiovascular diseases</topic><topic>Cause of Death - trends</topic><topic>Cholesterol</topic><topic>Confidence intervals</topic><topic>Coronary Angiography - methods</topic><topic>Coronary artery</topic><topic>Coronary artery disease</topic><topic>Coronary vessels</topic><topic>Coronary Vessels - diagnostic imaging</topic><topic>Diabetes</topic><topic>Electrocardiography</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Greece - epidemiology</topic><topic>Health risk assessment</topic><topic>Heart</topic><topic>Heart attacks</topic><topic>Heart diseases</topic><topic>Homocysteine</topic><topic>Hospitalization</topic><topic>Humans</topic><topic>Hypertension</topic><topic>Lesions</topic><topic>Male</topic><topic>Medical imaging</topic><topic>Medical prognosis</topic><topic>Methylenetetrahydrofolate reductase</topic><topic>Myocardial infarction</topic><topic>Patients</topic><topic>Polymorphism</topic><topic>Prognosis</topic><topic>Reduction</topic><topic>Reperfusion</topic><topic>Risk analysis</topic><topic>Risk factors</topic><topic>Smoking</topic><topic>ST Elevation Myocardial Infarction - diagnosis</topic><topic>ST Elevation Myocardial Infarction - mortality</topic><topic>Stents</topic><topic>Survival Rate - trends</topic><topic>Thrombosis</topic><topic>Time Factors</topic><topic>Ventricle</topic><topic>Vitamin B</topic><topic>Working groups</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Rallidis, Loukianos S, MD</creatorcontrib><creatorcontrib>Gialeraki, Argyri, PhD</creatorcontrib><creatorcontrib>Triantafyllis, Andreas S, MD</creatorcontrib><creatorcontrib>Tsirebolos, Georgios, MD</creatorcontrib><creatorcontrib>Liakos, Georgios, PhD</creatorcontrib><creatorcontrib>Moutsatsou, Paraskevi, MD</creatorcontrib><creatorcontrib>Iliodromitis, Efstathios, MD</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Proquest Nursing &amp; 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We compared the characteristics and long-term prognosis of patients with premature STEMI and N/NNCAs to their counterparts with significant coronary artery disease (CAD). We recruited 330 patients who had STEMI ≤35 years of age and 167 age and sex-matched controls. All patients underwent coronary angiography. Coronary arteries with no lesions or lesions causing &lt;30% reduction in lumen diameter were defined as N/NNCAs while narrowings causing ≥50% diameter reduction formed the significant CAD group. Lipid profile, homocysteine levels and methylenetetrahydrofolate reductase (MTHFR) C677T polymorphism were determined. Sixty patients (18%) had N/NNCAs. Patients with N/NNCAs had a more favourable lipid profile, i.e., lower low-density lipoprotein-cholesterol and higher high-density lipoprotein-cholesterol levels, higher homocysteine levels and higher prevalence of MTHFR TT genotype (34.6 vs 18%, p=0.008) compared to patients with significant CAD. After a median follow-up of 8 years, cardiovascular events occurred in 105 (36%) of 291 patients with available follow-up data. Significant CAD was associated with higher risk for recurrent cardiovascular events after adjustment for traditional risk factors (hazard ratio [HR] 2.095, 95% confidence interval [CI] 1.088-3.664, p=0.022) and additional adjustment for left ventricular ejection fraction, reperfusion therapy and persistent smoking (HR 1.869, 95% CI 1.007-3.468, p=0.041). In conclusion, patients with premature STEMI and N/NNCAs have fewer lipid abnormalities, higher homocysteine levels and prevalence of MTHFR TT genotype and better long-term prognosis compared to their counterparts with significant CAD.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>28689750</pmid><doi>10.1016/j.amjcard.2017.06.002</doi><tpages>7</tpages></addata></record>
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subjects Abnormalities
Acute coronary syndromes
Adult
Age
Angiography
Arteries
Atherosclerosis
Cardiovascular
Cardiovascular disease
Cardiovascular diseases
Cause of Death - trends
Cholesterol
Confidence intervals
Coronary Angiography - methods
Coronary artery
Coronary artery disease
Coronary vessels
Coronary Vessels - diagnostic imaging
Diabetes
Electrocardiography
Female
Follow-Up Studies
Greece - epidemiology
Health risk assessment
Heart
Heart attacks
Heart diseases
Homocysteine
Hospitalization
Humans
Hypertension
Lesions
Male
Medical imaging
Medical prognosis
Methylenetetrahydrofolate reductase
Myocardial infarction
Patients
Polymorphism
Prognosis
Reduction
Reperfusion
Risk analysis
Risk factors
Smoking
ST Elevation Myocardial Infarction - diagnosis
ST Elevation Myocardial Infarction - mortality
Stents
Survival Rate - trends
Thrombosis
Time Factors
Ventricle
Vitamin B
Working groups
title Characteristics and Long-Term Prognosis of Patients ≤35 Years of Age with ST-Segment Elevation Myocardial Infarction and “Normal or Near Normal” Coronary Arteries
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