Acute myocardial infarction in young patients – severe failures in the system of acute and secondary care

Česká verzia

Authors: G. Dostálová ¹; prof. MUDr. Jan Bělohlávek, Ph.D. ¹; L. Vítek ²; L. Muchová ²; M. Škvařilová ^3,4; D. Karetová ¹; K. Jirátová ¹; J. Kvasnička ²; D. Vondráková ⁵; O. Toman ⁶; A. Linhart ¹
Authors place of work: II. interní klinika – klinika kardiologie a angiologie 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Aleš Linhart, DrSc., FESC ¹; Ústav lékařské biochemie a laboratorní diagnostiky 1. lékařské fakulty UK a VFN Praha, přednosta prof. MUDr. Tomáš Zima, DrSc., MBA ²; I. interní kardiologická klinika Lékařské fakulty UP a FN Olomouc, přednosta doc. MUDr. Miloš Táborský, CSc., FESC, MBA ³; Kardiologické oddělení Karlovarské Krajské nemocnice, Karlovy Vary, přednosta prim. MUDr. Michal Paďour ⁴; Kardiologické oddělení Nemocnice Na Homolce Praha, přednosta prim. doc. MUDr. Petr Neužil, CSc., FESC ⁵; Interní kardiologická klinika Lékařské fakulty MU a FN Brno, pracoviště Bohunice, přednosta prof. MUDr. Jindřich Špinar, CSc., FESC ⁶
Published in the journal: Vnitř Lék 2012; 58(10): 721-729
Category: Original Contributions

Summary

Introduction:
The incidence of cardiovascular (CV) diseases and acute myocardial infarction (AMI) in Czech Republic is declining. In spite of this in a proportion of patients AMI occurs in young age. The aim of our project was to assess the character of risk factors, precipitating diseases and the quality of care in young AMI survivors.

Methods:
We included 132 patients (97 men and 35 women) in whom AIM with ST elevations occurred before age of 45 years in men and age of 50 years in women. Several results were compared to a control group composed of 84 healthy volunteers of comparable age. We assessed the course of the disease, extent of coronary involvement, subsequent therapy and control of risk factors after 3 years from the index event.

Results:
Smoking represented the main risk factor – 85% patents were active smokers at the time of AMI and 9% were former smokers, 64% patients had a positive family history of CV disease. We found a higher prevalence of dyslipidemia history in men. In spite of high rate of statin use, laboratory examination during follow-up revealed higher triglyceride values and low levels of HDL-cholesterol in both genders. All together 23% of patients had a history of provoking underlying disease or precipitating factors (inflammatory diseases, malignancies, combined thrombophilias, drug abuse). In total 95% of patients underwent coronary angiography during the acute phase of AMI, the median time from pain onset to intervention was 9 hours. Most patients had single vessel disease, 14% had even coronary angiogram without clinically significant stenosis. The subsequent care was satisfactory concerning the rate of drug prescriptions. However, target lipid values were not reached in 78% patients and blood pressure targets in 37%.

Conclusions:
In patients who suffered AMI in young age, risk factors are dominated by smoking and positive family history of CV diseases. One fifth of patients suffer from other underlying disease (inflammatory disease, malignancies, combined thrombophilia) or have another precipitating factor (febrile disease, drug abuse). The acute care seems unsatisfactory due to late arrival of most patients to catheterization laboratories (underestimation of the disease, incorrect initial diagnosis). Subsequent therapy is well composed but lacks in intensity.

Key words:
acute myocardial infarction – atherosclerosis – risk factors – secondary prevention

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