Young Post-myocardial Infarction Patients Research Articles

FLOW MEDIATED DILATATION, CAROTID INTIMA MEDIA THICKNESS, ANKLE BRACHIAL PRESSURE INDEX AND PULSE PRESSURE IN YOUNG MALE POST MYOCARDIAL INFARCTION PATIENTS

Introduction:Due to increase in Coronary Artery Disease (CAD) at a younger age, we should try to diagnose atherosclerotic process and population at risk, at the earliest. Flow Mediated Dilatation (FMD), Carotid Intima-Media Thickness (CIMT) and Ankle-Brachial Pressure Index (ABI) are probable markers for early atherosclerosis and may be useful in coronary risk stratification Objectives: To compare and correlate the FMD, CIMT, ABI and Pulse Pressure (PP) in young male patients of Myocardial Infarction (MI) with age and sex matched healthy controls Method50 patients of MI aged ≤45 years, who presented to iccu of Department of Medicine Indira Gandhi medical college Nagpur India, were recruited consecutively for this case control study and same number of age and sex matched healthy controls were also analyzed. 3 days after Myocardial infarction FMD of the brachial artery, intima media thickness of carotid artery, ABPI and PP were measured in the cases and compared with healthy control Results: The FMD was lower among young patients of MI than controls . CIMT was higher among cases than controls . ABI was lower among cases than controls . Compared to controls, PP was higher among cases . In all subjects, a negative correlation between FMD and CIMT and a positive correlation between FMD and ABPI was found. A statistically significant negative correlation was found between endothelial dependent FMD and PP among cases and control groups Conclusion: Biophysical parameters were deranged in young post MI patients. Majority of our young male patients fell in low risk Framingham risk score but still they manifested with CAD. Despite 3 days of treatment among young male patients of MI, various biophysical parameters were stillderanged.

Predictors of adverse outcomes in young post myocardial infarction patients under conditions of ambulatory rehabilitation

Predictors of adverse outcomes in young post myocardial infarction patients under conditions of ambulatory rehabilitation

Flow Mediated Dilatation, Carotid Intima Media Thickness, Ankle Brachial Pressure Index and Pulse Pressure in Young Male Post Myocardial Infarction Patients in India.

Due to increase in Coronary Artery Disease (CAD) at a younger age, we should try to diagnose atherosclerotic process and population at risk, at the earliest. Flow Mediated Dilatation (FMD), Carotid Intima-Media Thickness (CIMT) and Ankle-Brachial Pressure Index (ABI) are probable markers for early atherosclerosis and may be useful in coronary risk stratification. To compare and correlate the FMD, CIMT, ABI and Pulse Pressure (PP) in young male patients of Myocardial Infarction (MI) with age and sex matched healthy controls. Eighty male patients of MI aged ≤45 years, who presented to the Cardiac Care Unit and Department of Medicine of Guru Teg Bahadur Hospital, Delhi, India, from November 2010 to April 2012 were recruited consecutively for this case control study and same number of age and sex matched healthy controls were also analyzed. Six weeks after MI, FMD of the brachial artery, intima media thickness of carotid artery, ABPI and PP were measured in the cases and compared with healthy controls. The FMD was lower among young patients of MI than controls (p<0.001). CIMT was higher among cases than controls (p=0.001). ABI was lower among cases than controls (p<0.001). Compared to controls, PP was higher among cases (p=0.001). In all subjects, a negative correlation between FMD and CIMT (r=-0.220, p=0.005) and a positive correlation between FMD and ABPI (r=0.304, p<0.001) was found. A statistically significant negative correlation was found between endothelial dependent FMD and PP among cases and control groups (r=-0.209, p=0.007). Biophysical parameters were deranged in young post MI patients. Majority of our young male patients fell in low risk Framingham risk score but still they manifested with CAD. Despite six weeks of treatment among young male patients of MI, various biophysical parameters were still deranged.

High Doses of Clopidogrel to Overcome Genetic Resistance: The Randomized Crossover CLOVIS-2 (Clopidogrel and Response Variability Investigation Study 2)

This study sought to determine whether the pharmacokinetic (PK) and pharmacodynamic (PD) responses to high or standard clopidogrel loading doses (LDs) differ according to CYP2C19*2 allele. CYP2C19 loss-of-function alleles are associated with reduced responsiveness to standard clopidogrel doses. Young post-myocardial infarction patients heterozygous (wild type [wt]/*2, n = 43) or homozygous (*2/*2, n = 8) for the CYP2C19*2 genetic variant were matched with patients not carrying the variant (wt/wt, n = 58). All patients were randomized to a 300- or 900-mg clopidogrel LD. The relative reduction in residual platelet aggregation (RR-RPA, %) and the area under the plasma concentration time curve of active metabolite from baseline to 6 h after loading (AUC(0-6)) were compared according to both LD and CYP2C19*2 carriage. The 300-mg LD led to a gene-dose effect for RR-RPA (-65.7% ± 35.9% in wt/wt vs. -48.0% ± 38.4% in wt/*2 vs. -14.6% ± 32.4% in *2/*2; overall p value = 0.003, p = 0.03 for wt/wt versus wt/*2, p = 0.04 for wt/*2 versus *2/*2) with minor effect in *2/*2 carriers. After the 900-mg LD, the effect of the CYP2C19*2 variant on platelet inhibition was fully compensated in wt/*2 carriers but not in *2/*2 carriers (-83.6% ± 25.8% in wt/wt vs.-77.2% ± 26.9% in wt/*2 vs. -29.5% ± 26.8% in *2/*2; overall p value = 0.0003, p = 0.20 for wt/wt versus wt/*2, p < 0.001 for wt/*2 versus *2/*2). A similar pattern was observed for the active metabolite AUC(0-6) according to carriage of CYP2C19*2 for both LDs. There was a significant correlation between PK and PD responses irrespective of the LD. Carriers of CYP2C19*2 display significantly lower responses to clopidogrel with a gene-dose effect. Clopidogrel resistance can be overcome by increasing the dose in heterozygous carriers but not in homozygous carriers. (Clopidogrel and Response Variability Investigation Study 2 [CLOVIS-2]; NCT00822666).

Endothelial dysfunction, intima-media thickness, ankle-brachial pressure index, and pulse pressure in young post-myocardial infarction patients with various expressions of classical risk factors

Coronary risk assessment based on the presence of classical risk factors may be insufficient. Several markers of arterial function and morphology, such as endothelial dysfunction (ED), intima-media thickness (IMT), ankle-brachial pressure index (ABPI), and pulse pressure (PP) may be useful in coronary risk estimation. To investigate their usefulness, we compared them in young post-myocardial infarction (MI) patients with various expressions of classical risk factors. Young male patients (on average 44 years old) in the stable phase after MI were included in the study. Twenty patients had high and 21 patients low expression of risk factors, while 25 healthy age-matched males served as controls. Endothelial dysfunction (estimated by ultrasound measurement of the flow-mediated dilation [FMD] of the brachial artery), IMT (of common carotid arteries), ABPI, and PP were compared between both groups of patients and controls. Compared with the control group, endothelial function and IMT were significantly impaired in both groups of patients, whereas ABPI was significantly reduced only in high-risk patients, and PP was similar in patients and controls. In all subjects, the level of FMD was significantly negatively related to IMT (r = -0.38, P = 0.01). Our study showed that endothelial function and IMT (but not ABPI and PP) are impaired in young post-MI patients independently of presence or absence of classical risk factors. Thus, we conclude that in young patients ED and IMT better assess coronary disease than classical risk factors, and are probably better markers of coronary risk.

Altered Fibrin Architecture Is Associated With Hypofibrinolysis and Premature Coronary Atherothrombosis

Hypofibrinolysis promotes atherosclerosis progression and recurrent ischemic events in premature coronary artery disease. We investigated the role of fibrin physical properties in this particular setting. Biomarkers of recurrent thrombosis and premature coronary artery disease (CAD) were measured in 33 young post-myocardial infarction patients with angiographic-proven CAD and in 33 healthy volunteers matched for age and sex. Ex vivo plasma fibrin physical properties were assessed by measuring fibrin rigidity and fibrin morphological properties using a torsion pendulum and optical confocal microscopy. The fibrinolysis rate was derived from continuous monitoring of the viscoelastic properties after addition of lytic enzymes. Young CAD patients had a significant increase in plasma concentration of fibrinogen, von Willebrand factor, plasminogen activator inhibitor type 1, and lipoprotein(a) as compared with controls (P<0.05). Fibrin of young CAD patients was stiffer (P=0.002), made of numerous (P=0.002) and shorter fibers (P=0.04), and lysed at a slower rate than that of controls (P=0.03). Fibrin stiffness was an independent predictor for both premature CAD and hypofibrinolysis. This first detailed study of clot properties in such a group of patients demonstrated that abnormal plasma fibrin architecture is an important feature of both premature CAD and fibrinolysis rate. The determinants of this particular phenotype warrant further investigation.

Interleukin-6 Correlates with Endothelial Dysfunction in Young Post-Myocardial Infarction Patients

Background: The estimation of coronary risk based on consideration of classical risk factors is insufficient in young patients with myocardial infarction who have low expressions of classical risk factors. Endothelial dysfunction (ED) and markers of vascular inflammation may be more appropriate for risk estimation. The relations among ED and inflammation markers in such patients have not yet been explored. Patients and Methods: Twenty-one patients (on average 44 years old) in the stable phase after myocardial infarction, with low expressions of risk factors, were included in the study. The control group consisted of 25 healthy age-matched males. ED was estimated by ultrasound measurement of the endothelium-dependent dilatation of the brachial artery. The following inflammation markers were measured: hsCRP, interleukin-6 (IL-6), tumour necrosis factor-α (TNF-α), ICAM-1, VCAM-1, selectin-P and selectin-E. Results: Patients had a significantly reduced level of endothelium-dependent vasodilatation (5.6 ± 3.5 vs. 8.8 ± 6.5%, p < 0.05), and an increased level of IL-6 (3.2 [1.5–8.4] vs. 1.4 [0.9–2.3] ng/ml; p < 0.01). All other inflammation markers were comparable to controls. We found a significant negative correlation between ED and the levels of IL-6 (r = –0.54, p = 0.012). Conclusion: It appears that IL-6 is the most valuable circulating marker of ED, and consequently a useful marker of coronary risk.

Inflammation markers in young post-myocardial patients exhibiting various expressions of classic coronary risk factors

We investigated inflammation markers in young post-myocardial infarction patients exhibiting various expressions of classical risk factors. Forty-one male patients with high (n=20) and low (n=21) expression of classical risk factors (risk of coronary events calculated by the prospective cardiovascular Munster study program high or low, respectively), on average 44 years old, who were in the stable phase after myocardial infarction (on average 20.5 months after myocardial infarction) were included in the study. The control group consisted of 25 healthy, age-matched men. The following inflammation markers were measured: leukocyte count, high-sensitive C-reactive protein, interleukin-6, tumor necrosis factor-alpha, intracellular adhesion molecule-1, vascular cellular adhesion molecule-1, selectin-P and selectin-E. No differences in the levels of leukocytes, high-sensitive C-reactive protein, tumor necrosis factor-alpha, intracellular adhesion molecule-1, vascular cellular adhesion molecule-1, selectin-P and selectin-E were found between the group of patients and the controls. In contrast, interleukin-6 was significantly (P<0.01) elevated in the group of patients with high [2.5 (1.9-5.3) ng/ml] and low [3.2 (1.5-8.4) ng/ml] expression of risk factors compared with the controls [1.4 (0.9-2.3) ng/ml]. Significantly, there was no difference in interleukin-6 between the two groups of patients. We did not find differences in inflammation markers between young post-myocardial infarction patients with or without classical risk factors. Thus, it seems that the presence of (treated) risk factors or their absence does not affect the levels of inflammation markers in the stable period after myocardial infarction. Importantly, we found similarly elevated interleukin-6 in both groups of patients, most probably indicating slight local vascular inflammation. Interleukin-6 appears to be the most suitable marker of vascular inflammation in post-myocardial infarction patients who are aggressively treated pharmacologically.

Tu-P7:126 IL-5 Correlates with endothelial dysfunction in young post-myocardial infarction patients

Tu-P7:126 IL-5 Correlates with endothelial dysfunction in young post-myocardial infarction patients

Bezafibrate following acute myocardial infarction: important findings from the bezafibrate coronary atherosclerosis intervention trial

Summary Objective : The study was designed to assess whether bezafibrate could retard or prevent the progression of atherosclerotic lesions in young male survivors of myocardial infarction. Design : The study was of a randomized, parallel group double-blind design. Setting : Patients were recruited into the trial from the ten hospitals in Stockholm County. Interventions : After 3 months diet, patients who fulfilled the entry criteria were randomized to treatment with bezafibrate (200 mg tid), or placebo, for 5 years. Diet was continued throughout the trial. Main outcome measures : Quantitative computer assisted coronary angiography was undertaken at baseline and after 2 and 5 years, blood lipids were assessed every 4 months, and plasma fibrinogen was monitored before treatment, at 2 and 5 years. Results : Progression as assessed by mean minimum lumen diameter (MLD) was less in the bezafibrate group then in the placebo group. The treatment effect was +0.13 mm for the primary endpoint MLD ( P = 0.049). Supportive parallel treatment effects, although not reaching statistical significance, were observed for the secondary angiographic endpoints: mean segment diameter +0.02 mm and percent stenosis −3.41%. There was a significantly lower cumulative coronary event rate amongs patientst treated with bezafibrate (3 vs. 11: P = 0.019). The angiographic effects of bezafibrate were accompanied by statistically significant treatment effects for serum cholesterol (−9%), VLDL-cholesterol (−35%), serum triglycerides (−31%), VLDL-triglycerides (−37%), and plasma fibrinogen levels (−12%). There was no net change in LDL-cholesterol and HDL-cholesterol increased significantly by 9%. Conclusions : By correcting the underlying dyslipidaemia and the haemostatic imbalance, bezafibrate is able to slow the progression of coronary atherosclerosis in a group of young post-myocardial infarction patients.

Maximal Treadmill Exercise Testing in the Management of the Post-Myocardial Infarction Patient

Treadmill exercise tests were performed on 32 active duty military personnel 9 to 11 months after acute myocardial infarction to enable more objective selection of candidates for return to military service. Treadmill exercise tests were terminated at heart rates averaging 92 percent maximal predicted rate for age, or when chest discomfort with ischemic ECG changes occurred. The incidence of lipid abnormalities, hypertension, and other coronary risk factors did not differ among the groups. However, treadmill exercise tests appeared to identify a high risk group. Treadmill exercise testing in young postmyocardial infarction patients suggests that those with ischemic responses are at high risk of subsequent cardiac complications. Early surgery in this group may be warranted. The more frequently encountered negative response appears to be associated with a benign clinical course and better immediate prognosis.