Infarction In Young People Research Articles

ANALYSIS OF THE FREQUENCY AND STRUCTURE OF HOSPITALIZATION OF YOUNG PATIENTS IN A CARDIOLOGY HOSPITAL IN ALMATY

Objective: To study the frequency and structure of hospitalizations of young patients (up to 44 years old, WHO) at the Almaty City Cardiology Center for the period 2018–2022. Design and method: In the course of an observational, descriptive, cross-sectional study, we studied the frequency and structure of reasons for hospitalization in young patients over a five-year period. Results: During the study, it was found that during the designated period, a total of 1827 young patients were hospitalized (average age 36.7 ± 4.4 years), which amounted to 4.8% of the total number of hospitalized patients (n = 38054). Detailing by year, it should be noted that the peak of hospitalizations occurred in 2019 - 8.5%, with a significant decrease in 2020 - 4%, (which may have been due to the COVID-SARS-2 pandemic), while the minimum was recorded in 2018 - 3%. The most common cause of hospitalization (more than 30%) were acute forms of coronary heart disease, while the frequency of hospitalization with unstable angina (23.5%) prevailed over the myocardial infarction (12.2%). The third position was occupied by arterial hypertension - 9.9%. In descending order, the following nosologies followed: cardiomyopathies - 8.1% and acute myocarditis - 5.6%. The top ten most common reasons for hospitalization also included supraventricular tachycardia, atrial fibrillation/flutter, WPW syndrome. Analysis of the frequency of hospitalizations of patients with acute forms of coronary heart disease over the years demonstrated an upward trend. Among all hospitalizations of young patients with myocardial infarction, the most common was, according to the ICD-11 code (I21.0) -42.8%, then in descending order - (I21.1) -25.7%, (I21.4) -12.2%, (I22.1) -7.2%, (I22.0) -6.8% (I22.8) -2.3%. Conclusions: Thus, among all reasons for hospitalization, unstable angina, myocardial infarction and arterial hypertension occupied the three leading positions. Dynamics of the frequency of hospitalization of young patients with acute forms of coronary heart disease had an upward trend. The most common type of myocardial infarction in young people was acute transmural myocardial infarction of the left ventricle, which probably determines the severity of myocardial damage and the unfavorable prognosis in this population.

Myocardial infarction in young patients. Is everything so obvious?

The review is devoted to the analysis of literature data on the features of the course, diagnosis and treatment of myocardial infarction at a young age. Despite the relevance of the problem of myocardial infarction in young people, there is no specific approach to the management and examination of such patients in current clinical guidelines. Literature search was carried out in the following databases: PubMed, Google Scholar, Web of Science from 1990 to 2023 for all studies with the keywords “myocardial infarction and young age”, “atherosclerosis and young age”, “atherothrombosis and young age”. An analysis of all available clinical recommendations of leading specialized societies in the field of cardiology, hematology, and angiology was also carried out. The presented review is not systematic view of the specifics of the subject, its breadth, as well as the task set – to expand the clinical thinking of the doctor. It is undeniable that primary prevention of myocardial infarction is more effective. Given the annual increase in the number of myocardial infarctions at a young age, it is necessary to create a special tool for risk stratification in young patients, since there is no such tool in the clinical guidelines. Despite the greater contribution of non-atherogenic causes to the development of myocardial infarction in young patients, atherosclerosis is still the main cause of its development. The authors of the review confirm the fact that there is currently no specially developed algorithm for managing patients with myocardial infarction at a young age, based on the identification of a number of traditional and non-traditional risk factors, on enhanced rehabilitation measures. All these positions are currently formulated in the aims and objectives of a special sevenyear study of myocardial infarction in young patients planned at our institute.

Acute myocardial infarction in young people

Acute myocardial infarction in young people

SYNE1 gene novel variant is associated with myocardial infarction in young people with a family history of premature atherosclerosis

Abstract Introduction Genetic background is thought to be responsible for a family occurred premature atherosclerosis, including myocardial infarction (MI). Purpose The aim of the study was to investigate the role of genetic variants in young patients (aged <50 years) with MI and family history of premature atherosclerosis. Methods The studied group consisted of 70 patients aged 26-49 (mean 43.1, SD ±4.3), 17 women and 53 men, with MI and with family history of premature atherosclerosis, defined as MI or ischaemic stroke in first-degree relatives at age <65 years in women or <55 years in men. The mean BMI in the studied group was 28.8 kg/m2 (SD ±3.5), total cholesterol level 202.3 mg/dl (SD ±3.5), HDL 40.6 mg/dl (SD ±9.6), LDL 124.0 mg/dl (SD ±28.9), triglycerides 164.4 mg/dl (SD ±63.5), glucose 108.3 mg/dl (SD ±19.9) and creatinine 0.9 mg/dl (SD ±0.2). Regarding other risk factors 63 patients (90%) were smokers (mean 24.1 pack-years, SD ±13.0), 44 (62.8%) had hypertension, 11 (15.7%) had diabetes mellitus, and 8 (11.4%) had depression. All patients had diagnosed MI including MI with ST elevation (STEMI) in 18 cases (25.7%) and MI without ST elevation (NSTEMI) in 52 cases (74.3%). All patients, except 2 (no consent), had performed coronary angiography revealing 1-vessel coronary artery disease (VCAD) in 33 patients (47.1%), 2-VCAD in 17 patients (24.3%), and 3-VCAD in 20 patients (28.6%). The mean left ventricular ejection fraction (LVEF) was 51.8% (SD ±8.0). The total DNA has been extracted from whole peripheral blood samples. The targeted enrichment library was prepared and analyzed using New Generation Sequencing method on Hiseq4000, 2x150 cycles. Statistical analyses were performed using the R software package (www.r-project.org/). The results of sequencing were compared to data from the reference control population consisting of 597 healthy people (418 women, 179 men) aged 18-83 (mean 40.5, SD ± 12,4) as a whole and after matching with a studied group by age and gender in a proportion 1:3 (210 people, 51 women and 159 men, aged 18-77, mean 42.1, SD ±10.6) using Propensity Score Matching. Risks associated with detected variants were evaluated using Fisher’s exact test based on the allelic frequencies of variants in both groups. Results SYNE1 gene variant rs36215567 (NM_182961.4: c.20396+22A>G) has been detected in statistically significant higher incidence in the studied group in comparison to the control population (p=0.005) with OR=4,80 (95%CI 1,43-14,45) as well as when compared to the control population matched by age and gender (p=0.004) OR=9,31 (95%CI 1,64-95,41). There were no statistically significant differences in the incidence of familial hypercholesterolemia related gene variants: LDLR c.667G>A, PCSK9 c.658-36G>A, PCSK9 c.996+55C>A and APOB c.12382G>A between both cohorts. Conclusion A novel variant of SYNE1 gene is associated with myocardial infarction in young age patients with a family history of premature atherosclerosis.

Технологии искусственного интеллекта в прогнозировании генетических нарушений и персонализированной первичной и вторичной профилактике инфаркта мозга у лиц молодого возраста

Технологии искусственного интеллекта в прогнозировании генетических нарушений и персонализированной первичной и вторичной профилактике инфаркта мозга у лиц молодого возраста

Analysis of differentially expressed genes related to cerebral ischaemia in young rats based on the Gene Expression Omnibus database.

The incidence rate of cerebral infarction in young people is increasing day by day, the age of onset tends to be younger, and its internal pathogenesis and mechanism are very complicated, which leads to greater difficulties in treatment. Therefore, it is essential to analyze the key pathway that affects the onset of cerebral infarction in young people from the perspective of genetics. To compare the differentially expressed genes in the brain tissue of young and aged rats with middle cerebral artery occlusion and to analyse their effect on the key signalling pathway involved in the development of cerebral ischaemia in young rats. The Gene Expression Omnibus 2R online analysis tool was used to analyse the differentially expressed genes in the GSE166162 dataset regarding the development of cerebral ischaemia in young and aged groups of rats. DAVID 6.8 software was further used to filter the differentially expressed genes. These genes were subjected to Gene Ontology (GO) function analysis and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment analysis to determine the key gene pathway that affects the occurrence of cerebral ischaemia in young rats. Thirty-five differentially expressed genes (such as Igf2, Col1a2, and Sfrp1) were obtained; 73 GO enrichment analysis pathways are mainly involved in biological processes such as drug response, amino acid stimulation response, blood vessel development, various signalling pathways, and enzyme regulation. They are involved in molecular functions such as drug binding, protein binding, dopamine binding, metal ion binding, and dopamine neurotransmitter receptor activity. KEGG pathway enrichment analysis showed a significantly enriched pathway: The cyclic adenosine monophosphate (c-AMP) signalling pathway. The c-AMP signalling pathway might be the key pathway in the intervention of cerebral infarction in young people.

May Covid-19 Disease Cause Renal Infarction in Young People without Comorbidity?

May Covid-19 Disease Cause Renal Infarction in Young People without Comorbidity?

Is hyperhomocysteinemia a risk factor for myocardial infarction in young people?

Since the work of McCully in 1969, hyperhomocysteinemia (HHCY) has been considered to be responsible for early atherosclerosis and thromboembolic events. The objective of this study is to demonstrate the association between HHCY and the risk of MI in young subjects. We carried out a case-control study, the cases are young patients (age ≤ 45 years for men and ≤ 55 years for women) hospitalized for MI at the University Hospital in Constantine (Algeria). The group control are recruited in consultation of occupational medicine the age of inclusion is the same and they are free from any cardiovascular disease, diabetes, hypertension do not smoke and do not receive any treatment. Homocysteine was achieved in all patients and controls. 141 patients were compared to 112 controls. HHCY is found in 56% of patients against 41% in controls (OR estimated at 1.82 (95% CI, 1.07-3.10) P = 0.018. The mean of homocysteine is 18.87 ± 9.83 μmol/l in the patients while in the controls it is 15.58 ± 8.65 μmol/l, P = 0.005. This mean is significantly higher in sick men compared to controls P = 0,02, while there is no significant difference between sick women and controls P = 0,25. The profile of patients with HHCY was predominantly male, younger and more smokers. Hyperhomocysteinemia an unusual risk factor is common mainly in young male smokers. There is a link between the risk of MI in young adults and hyperhomocysteinemia.

Неатеросклеротическая васкулопатия как причина инфаркта головного мозга в молодом возрасте

Представлен аналитический обзор литературы по проблеме инфаркта головного мозга у лиц молодого возраста (18–45 лет). Показана актуальность диагностики и лечения инфаркта мозга у пациентов молодого возраста в Беларуси, Украине и Российской Федерации. В соответствии с общепризнанной концепцией гетерогенности инфаркта мозга рассмотрены некоторые редкие причины развития инсульта у лиц молодого возраста. Инфаркт мозга у данной категории пациентов отличается этиологическим полиморфизмом, имеет особенности течения и прогноза. Подробно рассмотрены неатеросклеротические васкулопатии, которые включают большую группу заболеваний с различными основными механизмами — иммунологические, инфекционные, патологию соединительной ткани. Большое внимание уделено диссекции сосудов головного мозга, причинам ее возникновения, особенностям клинических проявлений. Приведены результаты международных исследований, посвященных новым подходам к диагностике и лечению пациентов со спонтанной диссекцией, васкулитами, фибромускулярной дисплазией. Широкое внедрение в практику методов нейровизуализации головного мозга и улучшение качества неинвазивных ангиографических изображений способствовали более точной и своевременной диагностике и дифференциации васкулопатий, что имеет большое значение для дальнейшей тактики лечения. Вместе с тем наши исследования по изучению патогенетических характеристик инфаркта мозга у пациентов молодого возраста продолжаются и требуют дальнейшего уточнения.

The incidence of myocardial infarction in young people

Myocardial infarction (MI) occurs mainly in the population of middle-aged and elderly people, however, in recent years, the disease is increasingly developing in people under 45 years old, which, apparently, is associated with modern changes in lifestyle. Young men, smokers, people with a hereditary predisposition to the early development of cardiovascular pathology and having problems with employment are in the group at increased risk of early development of myocardial infarction. At a young age, the development of acute coronary syndrome with ST segment elevation on the electrocardiogram is most typical, which arose in patients without a previous history of angina pectoris. Rupture of the lining of atheroma as a cause of coronary thrombosis occurs in young people more often than erosion. Traditionally, in the pathogenesis of atherothrombosis, rupture of the atherosclerotic plaque cover is considered the key moment, which is more typical for atheroma with a large lipid core, thin cover and high inflammation activity. This plaque is traditionally called unstable. Tire erosion is more common in plaques with opposite characteristics and is more common in women and the elderly. Non-atherogenic causes of myocardial infarction at a young age can also be observed, for example, vasospasm, embolism in the coronary arteries in patients with endocarditis, etc. For the prognosis of the disease, it is important to assess the risk of complications, in particular, heart failure. It was found that young people have the lowest risk of its development.

ST-segment elevation acute myocardial infarction in young people: influence of age in the smoke paradox

Introduction and objectivesSmoking has been related with lower short-term mortality among patients with acute myocardial infarction. This may be caused by different baseline characteristics, since smokers are significantly younger at the time of infarction. Our purpose was to study the smoking paradox focusing on age. MethodsWe retrospectively studied 118 consecutive people aged<45 years and compared them to 236 patients aged 45–75 years, matched by sex and date of admission; all were admitted with an ST-segment elevation acute myocardial infarction (STEMI). Baseline characteristics, treatment patterns, cardiac catheterization parameters, in-hospital and 30 day-outcomes were thoroughly assessed and adjusted to the habit of smoking. ResultsArterial hypertension and diabetes mellitus, were more frequent in the older group (P<.005). Advanced Killip grade on admission (P=.030) and decreased creatinine clearance (P < 0.001) were more frequent in the ≥ 45-year cohort. The younger cohort displayed a trend to have higher pre/post PCI TIMI 3 percentages, collaterals and a good myocardial perfusion after PCI. Stratifying by smoking habit, non-smokers presented more frequently hypertension (P=.037), diabetes (P=.039), higher Killip degrees and less TIMI 3 post-PCI (P=.078). Thus, the combined event (MACE) and reinfarctions tended to be more frequent in non-smokers (P=.052 and P=.055). The overall multivariate model revealed a 30-day MACE-relationship with smoking habit (OR, 0.918; 95%CI, 0.854–0.987, P=.020). ConclusionsYoung smokers maintained the lower short-term events paradox. Our findings can contribute to explain the apparently different course of myocardial infarction in young people and point out a different mechanism of infarction in smokers.

A young man with acute anterior wall myocardial infarction after Cannabis abuse: Identification of perivascular edema of the culprit lesion after plaque rupture using cardiovascular magnetic resonance tomography

Canabis abuse is a rare but well-known und increasing cause of myocardial infarction in young people, predominantly in the male sex. Although the exact pathophysiological mechanism is not completely understood, several hypotheses have been proposed: coronary artery spasm due to alpha-adrenergic receptor stimulation; premature atherosclerosis with „classical “plaque formation and rupture resulting in thrombus formation with complete vessel closure. The latter model is supported by the fact that concomitant cigarette smoking is usual in cannabis drug abusers and represents a classical cardiovascular risk factor [1].

41例青年脑梗死的病因分析

目的：对青年人的脑梗死的危险因素进行分析和探讨，预防青年脑梗死的发生，提高其治愈率，降低其致残率和病死率。方法：通过对2013年10月~2016年10月期间在我院住院的41例青年脑梗死患者危险因素进行分析。结果：最常见的病因是血脂异常30例，占73.17%，其次为高血压27例(65.85%)，青年脑梗死的危险因素主要与体重、高胆固醇和不良嗜好有关(如吸烟和饮酒)。结论：青年人发生脑梗死的危险因素除与老年人脑梗死的危险因素有其共同点外，还与其吸烟、饮酒、家族史、体重和不良嗜好有关。 Objective: To analyze and explore the risk factors of cerebral infarction in young people, to prevent the occurrence and improve the cure rate of cerebral infarction in young people, and to reduce the morbidity and mortality. Methods: Analyze the risk factors of 41 young patients with cerebral infarction who were hospitalized in our hospital from October 2013 to October 2016. Results: the most common cause was abnormal blood lipid, accounted for 73.17%, followed by hypertension in 65.85%, the main risk factors of cerebral infarction in young adults are body weight, high cholesterol and bad habits (such as smoking and drinking). Conclusion: the risk factors of cerebral infarction in young people are not only related to the same risk factors in elderly people, but also related to smoking, drinking, family history, weight and bad habits.

Helicobacter pylori Infection Increase the Risk of Myocardial Infarction: A Meta‐Analysis of 26 Studies Involving more than 20,000 Participants

Myocardial infarction is a fatal cardiovascular disease and one of the most common death causes all around the world. The aim of the meta-analysis was to quantify the risk of myocardial infarction associated with Helicobacter pylori infection. A literature search was performed to identify studies published before 14 July, 2014, for relevant risk estimates. Fixed and random effect meta-analytical techniques were conducted for myocardial infarction. Twenty-six case-control studies involving 5829 myocardial infarction patients and more than 16,000 controls were included. Helicobacter pylori infection was associated with an increased risk of myocardial infarction (OR: 2.10, 95%CI: 1.75-2.53, p = .06). We also discovered a significant association between the bacteria and risk of myocardial infarction in young people (OR: 1.93, 95% CI: 1.41-2.66, p = .07), in elder people (OR: 2.02, 95% CI: 1.60-2.54, p = .29), in Caucasians (OR: 2.29, 95% CI: 1.99-2.63, p = .12), and in Asians (OR: 1.75, 95% CI: 1.12-2.73, p = .08). Our meta-analyses suggested a possible indication of relationship between Helicobacter pylori infection and the risk of myocardial infarction. The pathogenicity might not be affected by age and race. More researches should be conducted to explore the mechanisms involved.

Just another acute myocardial infarction?

Introduction: Acute Myocardial Infarction in young people can be challenging to manage, as the underlying pathology can be different to the conventional atherosclerosis with plaque rupture. Case Description: A 36-year old man presented with sudden onset central chest pain and diaphoresis. Apart from smoking he did not have other risk factors for coronary disease. One week prior he underwent elective hip replacement and had been treated with prophylactic clexane to prevent venous thromboembolism. He was on no other regular prescribed or recreational medication. The EKG showed changes consistent with an inferoposterior STEMI. Emergency angiography revealed an occluded left circumflex with heavy thrombus burden. Following prolific thrombus aspiration TIMI 3 flow was restored, the patient became pain-free and the EKG started to normalize. The circumflex artery appeared smooth with no evidence of plaque rupture. An embolic cause was suspected and given that the patient was pain-free he was managed medically with aspirin, clopidogrel, beta-blockers and ace inhibitors and planned to re-study him in 48 hours. Bilateral lower limb ultrasound and CT pulmonary angiography did not reveal deep vein thrombosis or pulmonary embolus. Transthoracic bubble echocardiography revealed right to left shunting on valsava manoevre consistent with a PFO, also visualized on 3D transesophageal echocardiography. At coronary angiography 48 hours later, the circumflex coronary remained smooth with no evidence of further obstruction thus no stent insertion was needed. Histology of the thrombus confirmed a platelet thrombus forming on a foreign plastic material that was likely part of an intravenous cannula. It is likely that the plastic entered the circumflex at the time of orthopedic surgery and acted as nidus for thrombus formation. He has since underwent successful percutaneous closure of his PFO. Discussion: Paradoxical coronary embolism is a rare but recognized clinical entity. It requires a high index of suspicion for diagnosis and should always be considered in young patients presenting with acute myocardial infarction and no obvious coronary lesion as its correct identification can guide appropriate management and preclude inappropriate stent implantation. Implications to clinical practice: 1. Always beware of paradoxical embolism in young patients presenting with a STEMI, particularly if coronary arteries appear smooth. 2. Always be meticulous when inserting intravenous cannulae. Avoid needle re-insertion as this increases the risk of the cannula breaking off and embolizing with adverse outcomes as exemplified in our case.

Circadian variation of acute myocardial infarction in young people

AimsThe aim was to investigate the circadian and weekly variation in Chinese young patients with acute myocardial infarction (AMI). MethodsThis was a 10-year retrospective cohort study. We studied patients (>18 to <45 years of age) with a first attack of AMI from the emergency departments of 3 university teaching hospitals in Taiwan from January 1, 2001, to December 31, 2010. We analyzed patients in the standard circadian fashion using 6-hour intervals (00:01-06:00, 06:01-12:00, 12:01-18:00, and 18:01-24:00). We also did an analysis by day of week. ResultsThe database had 505 patients with AMI with complete data. The percentage of total AMIs that occurred in the 6-hour intervals were as follows: 00:01 to 06:00, 30.9%; 06:01 to 12:00, 23.4%; 12:01 to 18:00, 25.9%; and 18:01 to 24:00, 19.8%. The percentage of AMIs between 00:01 and 06:00 was significant higher compared with that in the other three 6-hour intervals (df = 3, χ2 = 91.7, P < .001). However, there was no significant weekly variation for these patients in the present study. ConclusionsThere was a significant circadian variation with a peak from 00:01 to 06:00 in Chinese young patients with AMI. However, there was no significant weekly variation in these patients. The circadian periodicity may create new possibilities for disease prevention and medication prescription.

Migraine and cerebral infarction in young people

The objective of this study is to investigate relationship between migraine and cerebral infarction in young people. Patients aging 16-44 years, referred for stroke and age- and gender-matched controls were investigated for migraine following the International Headache Society criteria. Included people were 314 strokes and 314 controls. Each group consisted of 150 men and 164 women. Of the 105 persons with migraine (16.7%), 57 had migraine with aura (9.1%). In women, migraine with aura was related to stroke [35 women among strokes (21.3%) vs. 9 among controls (5.5%), P < 0.0001], whereas migraine without aura was not. After multivariate analysis, migraine with aura remained independently associated with stroke together with hypertension, and the estro-progestinic utilization. In men, migraine was not associated with stroke. In conclusion, migraine with aura appears to be associated with ischemic stroke in young women, independently from other common risk factors.

Comments on the article by Rallidis et al.: “Effects of smoking on myocardial infarction in young people”: Illicit drug addiction also contributes to major coronary events among youngsters

Among environmental factors influencing unfolding of acute coronary events among youngsters, tobacco smoking, a habit acquired at early ages, and illicit drug addiction, stand out. At young ages the myocardium is deprived of active collateral circulation to deal with an acute ischemic insult and major coronary events are predisposed to have serious consequences to cardiac mechanics, impacting lifestyle and quality of life. Planning strategies to reduce the impact of these injurious habits among young people should be considered by the organized and conscious society.

Effects of smoking on myocardial infarction in young people

Effects of smoking on myocardial infarction in young people

ApoE genotype as a risk factor of myocardial infarction in young people

ApoE genotype as a risk factor of myocardial infarction in young people