Clinical risk factors and outcomes of young patients with acute ST segment elevation myocardial infarction: a retrospective study.

BACKGROUND: This study aimed to analysis the clinical characteristics and prognosis of acute STEMI in patients aged ≤ 45 years. METHODS: Seven hundred and one patients with STEMI from Liaocheng People's Hospital from January 2018 to March 2021 were included in this study. Clinical characteristics, management, and outcomes (average follow-up: 11.5 months) were compared between patients aged ≤ 45 years and those aged > 45 years. RESULTS: Of the patients with STEMI who underwent primary percutaneous coronary intervention, 108 (15.4%) were aged ≤ 45 years. Compared to the older group, the younger patient group included more males, current smokers, and those with alcohol use disorder (AUD) or a family history of ischaemic heart disease (IHD). The culprit vessel in young patients was the left anterior descending (LAD) artery (60% vs. 45.9%, P = 0.031), which may have been due to smoking (odds ratio, 3.5; 95% confidence interval: 1.12-10.98, P = 0.042). Additionally, young patients presented with higher low-density lipoprotein and lower high-density lipoprotein levels than older patients; uric acid levels were also significantly higher in younger patients than that in the older group. Diabetes showed a trend toward major adverse cardiovascular events (MACE) in both groups; age and sex were both independent predictors of MACE in older patients. CONCLUSION: More patients who were smokers, had AUD, or a family history of IHD were present in the young patient group. Hyperuricaemia (but not dyslipidaemia) was a prevalent risk factor in patients aged ≤ 45 years. Diabetes should be controlled to reduce cardiovascular events in young patients.

In-hospital major adverse cardiovascular events after primary percutaneous coronary intervention in patients with acute ST-segment elevation myocardial infarction: a retrospective study under the China chest pain center (standard center) treatment system.

BACKGROUND: Patients with acute ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) are at high risk of major adverse cardiovascular events (MACE) despite timely treatment. This study aimed to investigate the independent predictors and their predictive value of in-hospital MACE after primary PCI in patients with acute STEMI under the China chest pain center (standard center) treatment system. METHODS: We performed a single-center, retrospective study of 151 patients with acute STEMI undergoing primary PCI. All patients were treated under the China chest pain center (standard center) treatment system. The data collected included general data, vital signs, auxiliary examination results, data related to interventional therapy, and various treatment delays. The primary endpoint was the in-hospital MACE defined as the composite of all-cause death, stroke, nonfatal recurrent myocardial infarction, new-onset heart failure, and malignant arrhythmias. RESULTS: In-hospital MACE occurred in 71 of 151 patients with acute STEMI undergoing primary PCI. Logistic regression analysis showed that age, cardiac troponin I (cTnI), serum creatinine (sCr), multivessel coronary artery disease, and Killip class III/IV were risk factors for in-hospital MACE, whereas estimated glomerular filtration rate (eGFR), left ventricular ejection fraction (LVEF), systolic blood pressure (SBP), diastolic blood pressure (DBP), were protective factors, with eGFR, LVEF, cTnI, SBP, and Killip class III/IV being independent predictors of in-hospital MACE. The prediction model had good discrimination with an area under the curve = 0. 778 (95%CI: 0.690-0.865). Good calibration and clinical utility were observed through the calibration and decision curves, respectively. CONCLUSIONS: Our data suggest that eGFR, LVEF, cTnI, SBP, and Killip class III/IV independently predict in-hospital MACE after primary PCI in patients with acute STEMI, and the prediction model constructed based on the above factors could be useful for individual risk assessment and early management guidance.

ST-segment elevation predicts the occurrence of malignant ventricular arrhythmia events in patients with acute ST-segment elevation myocardial infarction.

BACKGROUND: ST-segment elevation (STE) represents a repolarization dispersion marker underlying arrhythmogenesis in ST-segment elevation myocardial infarction (STEMI); however, its value for predicting malignant ventricular arrhythmia events (MVAEs) remains uncertain. METHODS: In total, 285 patients with STEMI and those with or without MVAEs who presented within 6 h of symptom onset were enrolled. The relationships between STE and clinical characteristics of MVAEs (defined as ventricular tachycardia or ventricular fibrillation) were analyzed using t-test, chi-square test, binary multivariate logistic regression, and receiver operating characteristic curve analysis. RESULTS: Patients with STEMI and MVAEs had a shorter time from symptom onset to balloon time (p = 0.0285) and greater STE (p < 0.01) than those without MVAEs. The symptom-to-balloon time, age, and STE were associated with MVAEs after stepwise regression analysis in all cases. Only STE was significantly associated with the occurrence of MVAEs (all, p < 0.01). The area under the curve (AUC) of STE for predicting MVAEs was 0.905, and the cut-off value was 4.5 mV. When only infarct-related arteries were included in the analysis, the AUC of the left anterior descending artery was 0.925 with a cut-off value of 4.5 mV, that of the right coronary artery was 0.915 with a cut-off value of 4.5 mV, and that of the left circumflex artery was 0.929 with a cut-off value of 4.0 mV. CONCLUSIONS: In patients with STEMI presenting within 6 h of symptom onset, age, symptom-to-balloon time, and STE were the main predictors for MVAEs. However, among these, STE was the strongest predictor for MVAEs and was an index for repolarization dispersion of cardiomyocytes in infarcted and non-infarcted areas.

Recurrent attack of acute myocardial infarction complicated with ventricular fibrillation due to coronary vasospasm within a myocardial bridge: a case report.

BACKGROUND: Myocardial bridge (MB) often an inoffensive condition that goes in one or more of the coronary arteries through the heart muscle instead of lying on its surface. MBs sometimes leads to myocardial ischemic symptoms such as chest pain, even an occurrence of myocardial infarction. However, reports of severe and recurrent cardiac adverse events related to the MBs are rare. CASE PRESENTATION: A 44-year-old male patient who suffered from a four-hour crushing chest pain ten years ago, was diagnosed as acute anterior ST-elevation myocardial infarction (STEMI). The initial findings of coronary angiography (CAG) showed MB was located in the middle part of the left anterior descending coronary artery (LAD). The patient was managed medically. Another re-attack of similar previous chest pain characteristics occured just after 3 days of discharge. Supra-arterial myotomy and CABG were the next adopted management. Postoperative progression was uneventful. However, 32 months after surgical treatment, the patient experienced an abrupt onset of chest pain accompanied by loss of consciousness. The ECG showed ventricular fibrillation (VF). After electrical cardioversion, an immediate CAG followed by CTA was performed which excluded thrombus or acute occlusion in the native coronary artery and an occlusion was observed at the end of the left internal mammary artery. An implantable cardioverter-defibrillator (ICD) was successfully performed for prevention of malignant arrhythmia. During ten years of follow-up, no complications have been identified. CONCLUSIONS: Although MB is mostly benign, it may lead to significant cardiovascular consequences. Supra-arterial myotomy is an appropriate treatment option for this patient who failed to optimal medical therapy. Furthermore, ICD implantation must be considered in order to prevent malignant ventricular arrhythmia caused by continuous spasm resulting in ischemia. Further investigations are required to confirm the clinical effectiveness of these procedures.

A giant aneurysm of the left anterior descending coronary artery in the setting of Behcet's disease.

Behcet's disease is a chronic inflammatory syndrome that can affect arteries and veins of all sizes and is an unusual cause of myocardial infarction. We report a case of a 42-year-old male with no cardiovascular risk factors who was referred to our department for a spontaneously resolving anterior ST-elevation myocardial infarction. Clinical and biological investigations revealed a high probability for Behcet's disease. The coronary angiogram showed severe left main artery stenosis with a huge coronary aneurysm of the proximal left anterior descending coronary artery, which was treated by aneurysm resection and coronary artery bypass grafting. Inflammatory arteritis should be considered in young patients with low cardiovascular risk presenting with acute coronary syndrome.

Acute anterior myocardial infarction in a 22-year-old male nephrotic patient along with familial hyperlipidaemia.

We report a case of acute myocardial infarction in a nephrotic male patient. A 22-year-old man with a 1-year history of nephrotic syndrome due to membranous nephropathy presented with acute chest pain and was admitted to our emergency room. An electrocardiogram showed ST elevation in leads consistent with anterior and inferior myocardial infarction. Subsequent cardiac catheterisation showed evidence of thrombotic occlusion of the anterior descending coronary artery. The patient had no long history of hypercholesterolaemia or hypertriglyceridaemia. The case suggests that young patients with a short-term nephrotic syndrome may be at an increased risk for acute coronary syndrome owing to hypercoagulability state.

A 42-year-old woman with acute myocardial infarction.

CLINICAL INTRODUCTION: A 42-year-old woman presented with anterior ST elevation myocardial infarction. Urgent coronary angiography revealed tapering then occlusion of the distal left anterior descending (LAD) coronary artery with no flow in the distal LAD (figure 1A). Balloon angioplasty with a 2.0×8 mm balloon re-established flow into the distal LAD. An angiogram of the right external iliac artery was also performed (figure 1B).heartjnl;104/19/1607/F1F1F1Figure 1Invasive angiography of the left coronary system (A) and the right external iliac artery (B). The coronary angiogram (A) shows tapering and then occlusion (arrow) of the distal left anterior descending coronary artery. QUESTION: Which of the following explains the abnormal appearance of the external iliac artery (figure 1B)?Atherosclerosis.Concertina effect.Fibromuscular dysplasia.Perforation.Multiple aneurysms.

Left Internal Thoracic Artery Graft to Left Anterior Descending Coronary Artery after Blunt-Chest-Trauma Myocardial Infarction: 14-Year Outcome.

In 2005, we reported an acute myocardial infarction secondary to a left anterior descending coronary artery injury sustained in a motorcycle accident. The treatment was late myocardial revascularization with in situ left internal thoracic artery-to-left anterior descending coronary artery anastomosis. There is little information available about the natural history of acute myocardial infarction after blunt chest trauma, especially when treated in this manner. This present communication reports the 14-year outcome in our patient.

Presentation of missed childhood Kawasaki disease in adults: Experience from a tertiary care center in north India.

AIM: Kawasaki disease (KD) is the most common cause of acquired heart disease in children in Japan, North America and Europe. Undiagnosed and untreated KD can have clinically significant consequences later in life. The clinical spectrum of missed childhood KD is frequently being recognized during adulthood. We report four adult cases of acute coronary events, in which coronary angiography was suggestive of sequelae of KD. METHODS: Four adults who presented with acute coronary events, had coronary angiography for evaluation. Indoor-admission files were analyzed for the clinical details of individual cases. RESULTS: Two cases were below 40 years of age. None of the patients had any known conventional risk factors for atherosclerosis. Case 4 had a clinical history of childhood KD. Coronary angiography revealed ectasia of multiple coronary arteries and stenosis in distal segments in the first three cases and large thrombosed aneurysm with calcified walls in the fourth case. CONCLUSION: We hereby report four adult cases with acute coronary events, who had markedly dilated coronary artery segments suggestive of possible sequelae of childhood KD.

Heavy Lifting Causing Spontaneous Coronary Artery Dissection with Anterior Myocardial Infarction in a 54-Year-Old Woman.

Spontaneous coronary artery dissection in association with strenuous exercise and weightlifting is rather sparsely described in the medical literature. Diagnosis and treatment of this rare condition is a challenge, but prompt recognition and appropriate early choice of angioplasty or surgery can lead to a good outcome. We report the case of a postmenopausal 54-year-old woman who presented with anterior myocardial infarction caused by spontaneous dissection of the left anterior descending coronary artery after she had lifted a heavy weight while gardening. The patient was treated successfully by means of angioplasty and the implantation of 3 drug-eluting stents. In addition to presenting the patient's case, we review the topical medical literature.

Acute Myocardial Infarction due to Left Atrial Myxoma.

Myxoma is a common benign cardiac tumor that may rarely cause an acute myocardial infarction. A 77-year-old woman was admitted to our hospital with chest pain. Electrocardiography showed an ST elevation in leads V3-6. Transthoracic echocardiography revealed an ovoid mass with fragmentation in the left atrium and hypokinesia of the left ventricular apex. Coronary angiography indicated the presence of a coronary embolism that was suspected to be from the left atrial mass. The mass was removed by emergency surgical resection to avoid a further systemic embolism and was diagnosed pathologically as a myxoma. The patient was discharged after 13 days with no complications.

Unexpected Coronary Thrombosis Induced By Antiphospholipid Syndrome (Hughes Syndrome): Case Report.

Antiphospholipid syndrome (APS), one of the most common states of acquired hypercoagulability, is diagnosed by the persistent presence of antiphospholipid antibodies and recurrent episodes of vascular thrombosis. We present the case of a 39-year-old man late-presenting for cardiac rehabilitation treatment after primary percutaneous coronary intervention (PCI) performed for anteroseptal myocardial infarction. He was a nonsmoker, with no prior personal history of other cardiovascular diseases (CVD) or cardiometabolic syndrome. The 60% thrombotic occlusion of the left anterior descending artery (LAD) leading to the acute cardiac event was the only abnormality that was found. The only etiological explanation was the late measurement and the positive tests for antiphospholipid antibodies. In young patients with no history of thrombotic disorder, such as cancer, cardiovascular or metabolic diseases, the unexpected onset of myocardial infarction by thrombotic coronary occlusion can be attributed to silent, undiagnosed autoimmune condition.

Granulocyte colony-stimulating factor therapy for stem cell mobilization following anterior wall myocardial infarction: the CAPITAL STEM MI randomized trial.

BACKGROUND: Small studies have yielded divergent results for administration of granulocyte colony-stimulating factor (G-CSF) after acute myocardial infarction. Adequately powered studies involving patients with at least moderate left ventricular dysfunction are lacking. METHODS: Patients with left ventricular ejection fraction less than 45% after anterior-wall myocardial infarction were treated with G-CSF (10 µg/kg daily for 4 days) or placebo. After initial randomization of 86 patients, 41 in the placebo group and 39 in the G-CSF group completed 6-month follow-up and underwent measurement of left ventricular ejection fraction by radionuclide angiography. RESULTS: Baseline and 6-week mean ejection fraction was similar for the G-CSF and placebo groups: 34.8% (95% confidence interval [CI] 32.6%-37.0%) v. 36.4% (95% CI 33.5%-39.2%) at baseline and 39.8% (95% CI 36.2%-43.4%) v. 43.1% (95% CI 39.2%-47.0%) at 6 weeks. However, G-CSF therapy was associated with a lower ejection fraction at 6 months relative to placebo (40.8% [95% CI 37.4%-44.2%] v. 46.0% [95% CI 42.7%-44.3%]). Both groups had improved left ventricular function, but change in left ventricular ejection fraction was lower in patients treated with G-CSF than in those who received placebo (5.7 [95% CI 3.4-8.1] percentage points v. 9.2 [95% CI 6.3-12.1] percentage points). One or more of a composite of several major adverse cardiac events occurred in 8 patients (19%) within each group, with similar rates of target-vessel revascularization. INTERPRETATION: In patients with moderate left ventricular dysfunction following anterior-wall infarction, G-CSF therapy was associated with a lower 6-month left ventricular ejection fraction but no increased risk of major adverse cardiac events. Future studies of G-CSF in patients with left ventricular dysfunction should be monitored closely for safety. TRIAL REGISTRATION: ClinicalTrials.gov, no. NCT00394498.

Epicardial fibrosis mimicking a myocardial bridge.

Coronary artery compression during left ventricular systole is usually the result of a segment of coronary artery tunnelling within the myocardium, termed a 'myocardial bridge'. A 49-year-old man presented with acute anterior wall myocardial infarction thought to be secondary to a myocardial bridge seen during coronary arteriography; however, in the operating room the entire left anterior descending artery had a normal epicardial course without evidence of an intramyocardial segment, and coronary artery compression was the result of overlying fibrotic tissue, which was successfully excised. Overlying epicardial coronary artery fibrosis should be in the differential diagnosis of coronary artery compression.

ST-segment elevation after abdominal aortic aneurysm repair.

We describe a case of post-operative inferior myocardial infarction after abdominal aortic aneurysm repair due to compromise of a gastroepiploic coronary arterial graft.

Acute myocardial infarction in early postpartum.

We present a case of acute anterior myocardial infarction in a breastfeeding woman, 10 days after delivery. The presumed cause was proximal left anterior artery vasospasm, induced by a combination of smoking a first cigarette in the early morning and salbutamol inhalation, in the particular context of peripartum. We discuss briefly the epidemiology, pathophysiology, risk factors, diagnosis, treatment and prognosis of myocardial infarction related to pregnancy and the postpartum period.