Title: Myocardial Infarction in Young Indian Patients Risk Factors Analysis

Authors: Dr Subhash Chandra, Dr Pankaj Kumar Jain

 DOI:  https://dx.doi.org/10.18535/jmscr/v6i4.173

Abstract

Background: Coronary artery disease (CAD) mostly occurs in persons older than 45 years of age. In India, CAD manifests almost a decade earlier than in Western countries. This study was done to study the risk factors and in some patients angiographic profile of young patients presenting with myocardial infarction (MI).

Patients and Methods: Three hundred and fifty one consecutive patients presenting with MI in less than and equal to 45 years of age were studied for risk factors. Coronary angiography was done in some patients.

Results: Out of 351 patients, 321 were male (91.45%). Most common age group was 36-45 yrs (68.66%), 322 had ST elevation myocardial infarction (MI) (91.74%) and 29 had non ST elevation MI (8.26%). Anterior wall MI was present in 234 patients (66.67%), inferior wall MI in 84 patients (23.93%) and lateral wall MI in 04 patients (1.14%), 162 patients (46.15%) were smoker. Dyslipidemia was present in 120 patients (34.19%), 50 patients were hypertensive (14.25%), 36 patients were diabetic (10.25%). Family history of CAD was present in 35 (9.97%) patients, 32 patients (9.12%) were obese or overweight and 16 patients (4.56) had history of illicit drug use.

Conclusion: MI in young almost exclusively occurs in male, and ST elevation MI is the main presentation. Anterior wall MI is most common. Smoking, low HDL, high triglycerides and hypertension are the major risk factors. Diabetes mellitus type 2, positive family history, obesity and illicit drug use are the other risk factors.

References

  1. Avezum A, Makdisse M, Spencer F, Gore JM, Fox KA, Montalescot G, et al. Impact of age on management and outcome of acute coronary syndrome: Observations from the Global Registry of Acute Coronary Events (GRACE)Am Heart J. 2005;149:67–73. 
  2. Tungsubutra W, Tresukosol D, Buddhari W, Boonsom W, Sanguanwang S, Srichaiveth B, et al. Acute coronary syndrome in young adults: The Thai ACS Registry.J Med Assoc Thai 2007;90:81–90. 
  3. Morillas P, Bertomeu V, Pabón P, Ancillo P, Bermejo J, Fernández C, et al. Characteristics and outcome of acute myocardial infarction in young patients. The PRIAMHO II study.2007;107:217–25
  4. Padler FA, Comad AR. Myocardial infarction with normal coronary artery: A case report and review of literature.Am J Med Sci. 1997;314:342–5. 
  5. Penny WJ, Colvin BT, Brooks N. Myocardial infarction with normal coronary arteries and factor XII deficiency.Br Heart J. 1985;53:230–4. 
  6. Hamsten A, Norberg R, Björkholm M, de Faire U, Holm G. Antibodies to cardiolipin in young survivors of myocardial infarction: An association with recurrent cardiovascular events.1986;1:113–6.
  7. Fujimura O, Gulamhusein S. Acute myocardial infarction: Thrombotic complications of nephrotic syndrome.Can J Cardiol. 1987;3:267–9. 
  8. Ross GS, Bell J. Myocardial infarction associated with inappropriate use of cocaine for treating epistaxis.Am J Emerg Med. 1992;10:219–22. 
  9. Moreyra AE, Kostis JB, Passannante AJ, Kuo PT. Acute myocardial infarction in patients with normal coronary arteries after acute ethanol intoxication.Clin Cardiol 1982;5:425–30. 
  10. Milonig G, Malcolm GT, Wick G. Early inflammatory and immunological lesions in juvenile atherosclerosis from the pathological determinants of atherosclerosis in youth (PDAY) study. 2002;160:444–8. 
  11. Zimmerman FH, Cameron A, Fisher LD, Ng G. Myocardial infarction in young adults: Angiographic characteristics, risk factors and prognosis, coronary artery surgery study register (CASS)J Am Coll Cardiol. 1995;26:654–61. 
  12. 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 less than 40 years old.Am J Cardiol. 2003;92:1465–7. 
  13. Chen L, Chester M, Kaski JC. Clinical factors and angiographic features associated with premature coronary artery disease. 1995;108:364–9. 
  14. Xie CB, Chan MY, Teo SG, Low AF, Tan HC, Lee CH. Acute myocardial infarction in young Asian women: A comparative study on Chinese, Malay and Indian ethnic groups.Singapore Med J.2011;52:835–9. 
  15. Lee BW, Tay JS, Yip WC, Yap HK, Chan KY, Low PS. Kawasaki syndrome in Chinese children.Ann Trop Pediatric 1989;9:147–51. 
  16. Hill LD, Antonius JI. Arterial dysplasia: An important surgical lesion.Arch Surg. 1965;90:585–95.
  17. Pate GE, Lowe R, Buller CE. Fibromuscular dysplasia of the coronary and renal arteries? Catheter Cardiovasc Interv. 2005;64:138–45.

Corresponding Author

Dr Pankaj Kumar Jain

Senior Resident, Department of Medicine,

G.R. Medical College, Gwalior (M.P.)