Journal of Tehran University Heart Center

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The Journal of Tehran University Heart Center Seyed Kianoosh Hosseini et al. patients, smokers, and those with a family history of CAD have the propensity to earlier acute coronary syndromes (ACSs). 16-18 In the Sozzi et al. study, 18 the men developed AMI approximately 10 times more frequently than did the women, and also smoking and a family history were heavily present among the young patients. Zimmerman et al. 1 showed that a family history of premature CAD was more common in the young men with MI. A family history of premature MI has been considered as an independent risk factor for the development of cardiovascular events, particularly in young patients. 19-22 The role of positive family history of premature CAD will be completed by many reports about the role of genetic factors in the development of atherosclerosis and occurrence of STEMI in young patients. According to recent published studies, there may be polymorphisms in genes such as methylene tetrahydrofolatereductase, 23 Platelet receptors, 24 and plasminogen activator inhibitor 1 (PAI1), 25 which predispose the patients to STEMI. In contrast, there is at least one report about the polymorphism in beta fibrinogen gene and its protective effect against the incidence of premature STEMI. 26 Whether or not such findings could have therapeutic impacts needs to be illuminated in the future. As was expected, there was a lower incidence of hypertension, dyslipidemia, and diabetes in our younger 17, 27, patients, which is in agreement with previous studies. 28 It is related to the long-term role of these metabolic and endocrine disorders in the atherosclerosis process and ACS. However, it is deserving of note that our young patients had higher levels of serum triglyceride. These findings suggest that coronary disease may have different predisposing conditions in this population. Early lifestyle modifications and pharmacological interventions should take into account smoking, dyslipidemia, and body weight control. It should be noted that hypertension and diabetes were less frequent at the young age. A general notion has evolved that the intensity of preventive efforts should be adjusted to a patient’s risk for developing CAD. Our findings that a normal coronary angiogram was more frequent in the young patients and that they had a higher frequency of single-vessel disease as compared to the older patients are consistent with previous reports. 1, 3, 29 Our older patients were more commonly diagnosed as multi-vessel disease in the coronary angiogram. It seems that younger patients who present with STEMI have lower atherosclerotic burden but higher propensity to thrombus formation. Autopsy observations have shown that the occurrence of MI in young people with cardiovascular risk factors could be the expression of a premature and severe atherosclerotic process. 30 Not surprisingly, we observed that the young patients were less likely to have prior catheterization and to refer for CABG as their treatment strategy for coronary revascularization. The current analysis is strengthened by the diversity and size of the population studied; be that as it may, a number of limitations should be noted. Patients ≤ 35 years of age comprised just 1.9% of the total STEMI population in the angiography registry, but this analysis of 5652 patients of STEMI represents one of the largest studies to focus on patients after infarction. As this study population represented relatively high-risk patients with MI, we remain cautious in generalizing these results to a broader group of lowerrisk, post-MI patients. Furthermore, our patients had been followed prospectively through other registries (i.e. Angioplasty and CABG); nevertheless, the present study, being a single-center survey may have lost some data of the patients who were not admitted. Some long-term follow-up events, particularly death and stroke, were not determined in this study. Accordingly, the present analysis cannot claim to represent the findings for all patients early after MI. Conclusion In conclusion, we found that the male gender, smoking, family history of cardiovascular diseases, and hypertriglyceridemia were more prevalent in the STEMI patients ≤ 35 years, whereas the elderly patients were more likely to have dyslipidemia, hypertension, and diabetes. Medical treatment or PCI were the preferred therapeutic strategy recommended to the younger patients in contrast to their older counterparts, in whom CABG was more commonly recommended. Further studies about the impact of genetic factors in the development of STEMI in young patients are needed. Acknowledgment We extend our gratitude to Dr. Mahmood Sheikhfathollahi for his assistance in the statistical analysis. This study was approved and supported by Tehran University of Medical Sciences. References 1. Zimmerman FH, Cameron A, Fisher LD, Ng G. Myocardial infarction in young adults: angiographic characterisation, risk factors and prognosis (Coronary Artery Surgery Study Registry). J Am Coll Cardiol 1995;26:654-661. 2. Colkesen AY, Acil T, Demircan S, Sezgin AT, Muderrisoglu H. Coronary lesion type, location, and characteristics of acute ST elevation myocardial infarction in young adults under 35 years of age. Coron Artery Dis 2008;19:345-347. 3. Pineda J, Marín F, Roldán V, Valencia J, Marco P, Sogorb F. Premature myocardial infarction: clinical profile and angiographic findings. Int J Cardiol 2008;126:127-129. 4. Ghadimi H, Bishehsari F, Allameh F. Clinical characteristics, hospital morbidity and mortality, and up to 1-year follow-up events of acute myocardial infarction patients: the first report from Iran. 66
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Eur Heart J 2002;23:1655-1663. 20. Sesso HD, Lee IM, Gaziano JM. Maternal and paternal history of TEHRAN HEART CENTER myocardial infarction and risk of cardiovascular disease in men and women. Circulation 2001;104:393-398. 21. Philips B, de Lemos JA, Patel MJ. Relation of family history of myocardial infarction and the presence of coronary arterial calcium in various age and risk-factor groups. Am J Cardiol 2007;99:825- 829. 22. Hoseini K, Sadeghian S, Mahmoudian M, Hamidian R, Abbasi A. Family history of cardiovascular disease as a risk factor for coronary artery disease in adult offspring. Monaldi Arch Chest Dis 2008;70:84-87. 23. Isordia-Salas I, Trejo-Aguilar A, Valadés-Mejía MG, Santiago- Germán D, Leaños-Miranda A, Mendoza-Valdéz L, Jáuregui- Aguilar R, Borrayo-Sánchez G, Majluf-Cruz A. C677T polymorphism of the 5,10 MTHFR gene in young Mexican subjects with ST-elevation myocardial infarction. Arch Med Res 2010;41:246-250. 24. 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Int J Cardiol 1998;67:75-80. 28. Cole JH, Miller JI, 3rd, Sperling LS, Weintraub WS. Long-term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol 2003;4:521-528. 29. Fullhaas J, Rickenbacher P, Pfisterer M. Long-term prognosis of young patients after myocardial infarction in the thrombolytic era. Clin Cardiol 1997;20:993-998. 30. Genest JJ, McNamara JR, Salem DN, Schaefer EJ. Prevalence of risk factors in men with premature coronary artery disease. Am J Cardiol 1991;67:1185-1189. The Journal of Tehran University Heart Center67
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