Myocardial infarction in young patients. Is everything so obvious?
https://doi.org/10.38109/2225-1685-2024-1-108-115
Abstract
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.
About the Authors
M. V. Zykov
Research Institute for Complex Problems of Cardiovascular Diseases;
Russian Federation
Russian Federation
Mikhail V. Zykov, Dr. of Sci. (Med.), Leading Researcher, Laboratory of Neurovascular Pathology, Department of Clinical Cardiology; Associate Professor, the Department of Medical Rehabilitation; Head of the Cardiology Department, Hospital No. 4
Academician L.S. Barbarash Boulevard, 6, Kemerovo 650002
ResearcherID: N-9272-2016
O. L. Barbarash
Research Institute for Complex Problems of Cardiovascular Diseases; Kuban State Medical University
Russian Federation
Russian Federation
Olga L. Barbarash, Dr. of Sci. (Med.), professor, academician of the Russian academy of science, director
Academician L.S. Barbarash Boulevard, 6, Kemerovo 650002
Mitrofan Sedin Street, 4, Krasnodar 350063
References
1. Yang J., Biery D.W., Singh A. et al. Risk factors and outcomes of very young adults who experience myocardial infarction: The Partners YOUNG-MI Registry. Am J Med. 2020;133(5):605-612. https://doi:10.1016/j.amjmed.2019.10.020
2. Wu W.Y., Berman A.N., Biery D.W., Blankstein R. Recent trends in acute myocardial infarction among the young. Curr Opin Cardiol. 2020;35(5):524-530. https://doi:10.1097/HCO.0000000000000781
3. Collet J.-P., Thiele H., BarbatoE., Barthélémy O. et al. 2020 ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation. Eur Heart J. 2021;42(14):1289-1367. https://doi:10.1093/eurheartj/ehaa575
4. Fourth universal definition of myocardial infarction (2018). Russian Journal of Cardiology. 2019;(3):107-138 (In Russ.) https://doi. org/10.15829/1560-4071-2019-3-107-138
5. Gao H., Wang Y., Shen A., Chen H. et al. Acute myocardial infarction in young men under 50 years of age: clinical characteristics, treatment, and long-term prognosis. Int J Gen Med. 2021;14:9321-9331. https://doi.org/10.2147/IJGM.S334327
6. Anjum M., Zaman M., Ullah F. Are their young coronaries old enough? Angiographic findings in young patients with acute myocardial infarction. J Ayub Med Coll Abbottabad. 2019;31:151-155. https://pubmed.ncbi.nlm.nih.gov/31094106/
7. Sinha S.K., Krishna V., Thakur R. et al. Acute myocardial infarction in very young adults: A clinical presentation, risk factors, hospital outcome index, and their angiographic characteristics in North IndiaAMIYA Study. ARYA Atheroscler. 2017; 13(2):79-87. https://pubmed.ncbi.nlm.nih.gov/29026414/
8. Reynolds H.R., Srichai M.B., Iqbal S.N. et al. Mechanisms of myocardial infarction in women without angiographically obstructive coronary artery disease. Circulation. 2011;124:1414-1425. https://doi:10.1161/CIRCULATIONAHA.111.026542
9. Khraishah H., Karout L., Jeong S.Y. et al. Clinical characteristics and cardiovascular outcomes among young patients with acute myocardial infarction in Kerala, India: A secondary analysis of ACS QUIK trial. Atherosclerosis Plus. 2022;50:25-31. https://doi.org/10.1016/j.athplu.2022.08.003
10. Gao J., Wang J., Feng L. et al. Clinical characteristics and outcomes in premature(≤45 years) acute myocardial infarction: a cohort study. Journal of Chinese Physician. 2021; 358(12):347-353. https://pesquisa.bvsalud.org/portal/resource/pt/wpr-884054
11. Pandey R., Maskey A., Shrestha B. et al. Angiograhic profile and in-hospital outcome of young patients presenting with ST Elevation Myocardial Infarction (STEMI) in tertiary cardiac hospital. JAIM. 2021;10(2):76-79. https://doi.org/10.3126/jaim.v10i2.42175
12. Ambroziak M., Niewczas-Wieprzowska K., Maicka A., Budaj A. Younger age of patients with myocardial infarction is associated with a higher number of relatives with a history of premature atherosclerosis. BMC Cardiovascular Disorders. 2020;20:410. https://doi.org/10.1186/s12872-020-01677-w
13. Rubin J.B., Borden W.B. Coronary heart disease in young adults. Curr Atheroscler Rep. 2012;14:140-149. https://doi.org/10.1007/s11883-012-0226-3
14. Liu Q., Shi R.-J., Zhang Y.-M. et al. Risk factors, clinical features, and outcomes of premature acute myocardial infarction. Front Cardiovasc Med. 2022;9:1012095. https://doi.org/10.3389/fcvm.2022.1012095
15. McGorrian C., Yusuf S., Islam S. et al. Estimating modifiable coronary heart disease risk in multiple regions of the world: the INTERHEART Modifiable Risk Score. Eur Heart J. 2011;32(5):581-589. https://doi.org/10.1093/eurheartj/ehq448
16. Andreenko E.Yu., Yavelov I.S., Loukianov М.М., Vernohaeva A.N., Drapkina O.M., Boytsov S.A. Ischemic Heart Disease in Subjects of Young Age: Current State of the Problem. Features of Etiology, Clinical Manifestation and Prognosis. Kardiologiia. 2018;58(11):24-34. (In Russ.). https://doi.org/10.18087/cardio.2018.11.10195
17. Ershova A.I., Meshkov A.N., Bazhan S.S. et al. The prevalence of familial hypercholesterolemia in the West Siberian region of the Russian federation: A substudy of the ESSE-RF. PLoS One. 2017;12(7):e0181148. https://doi:10.1371/journal.pone.0181148
18. Barbarash O.L., Duplyakov D.V., Zateischikov D.A. et al. 2020 Clinical practice guidelines for Acute coronary syndrome without ST segment elevation. Russian Journal of Cardiology. 2021;26(4):4449. (In Russ.). https://doi.org/10.15829/1560-4071-2021-4449
19. Ezhov M.V., Kukharchuk V.V., Sergienko i.V. et al. Disorders of lipid metabolism. Clinical Guidelines 2023. Russian Journal of Cardiology. 2023;28(5):5471. (In Russ.). https://doi.org/10.15829/1560-4071-2023-5471
20. Kronenberg F., Mora S., Stroes E.S.G. et al. Lipoprotein(a) in atherosclerotic cardiovascular disease and aortic stenosis: a European Atherosclerosis Society consensus statement. Eur Heart J. 2022; 43(39):3925-3946. https://doi.org/10.1093/eurheartj/ehac361
21. Mach F., Baigent C., Catapano A.L. et. 2019 ESC/EAS Guidelines for themanagement of dyslipidaemias: lipid modification to reduce cardiovascular risk The Task Force for the management of dyslipidaemias of the European Society of Cardiology (ESC) and European Atherosclerosis Society (EAS). Europ Heart J. 2020;41:111188. https://doi.org/10.1093/eurheartj/ehz455
22. Lau F.D., Giugliano R.P. Lipoprotein(a) and its significance in cardiovascular disease a review. JAMA Cardiol. 2022;7(7):760-769. https://doi.org/10.1001/jamacardio.2022.0987
23. Gaudet D., Kereiakes D.J., McKenney J.M. et al. Effect of alirocumab, a monoclonal proprotein convertase subtilisin/kexin 9 antibody, on lipoprotein(a) concentrations (a pooled analysis of 150 mg every two weeks dosing from phase 2 trials). Am J Cardiol. 2014;114:711-715. https://doi.org/10.1016/j.amjcard.2014.05.060
24. Zyryanov S.K., Butranova O.I. New opportunities for lowering lowdensity lipoprotein cholesterol: comparative characteristics of PCSK9- targeted therapy. Russian Journal of Cardiology. 2022;27(11):5271. (In Russ.). https://doi.org/10.15829/1560-4071-2022-5271
25. Shushanova A.S., Gladkih N.N., Yagoda A.V. Type 1 myocardial infarction at a young age: the contribution of proatherogenic factors and genetic thrombophilias. Terapiya. 2023;4:30-37. (In Russ.). https://dx.doi.org/10.18565/therapy.2023.4.30-37
26. Arachchillage D.J., Mackillop L., Chandratheva A. et al. Thrombophilia testing: A British Society for Haematology guideline. Br J Haematol. 2022;198:443-458. https://doi.org/10.1111/bjh.18239
27. Reshetnyak T.M., Nurbaeva K.S. Direct-acting oral anticoagulants in antiphospholipid syndrome. Rheumatology Science and Practice. 2020;58(6):708-715. (In Russ.). https://doi.org/10.47360/1995-4484-2020-708-715
28. Ramjas V., Jain A., Lee R.M. et al. Unraveling the association between myocardial infarction of nonobstructive coronary arteries and antiphospholipid syndrome. Cureus. 2018;13(8):e17002. https://doi.org/10.7759/cureus.17002
29. Vandevelde A., Devreese K.M.J. Laboratory diagnosis of antiphospholipid syndrome: insights and hindrances. J Clin Med. 2022;11(8):2164. https://doi.org/10.3390/jcm11082164
30. Nazir S., Tachamo N., Lohani S. et al. Acute myocardial infarction and antiphospholipid antibody syndrome: a systematic review. Coron Artery Dis. 2017;28:332-335. https://doi.org/10.1097/MCA.0000000000000476
31. Gandhi H., Ahmed N., Spevack D.M. Prevalence of myocardial infarction with non-obstructive coronary arteries (MINOCA) amongst acute coronary syndrome in patients with antiphospholipid syndrome. Int J Cardiol Heart Vasc. 2019;22:148-149. https://doi.org/10.1016/j.ijcha.2018.12.015
32. Pervez H., Rufus S., Gopalakrishnan P. In-situ coronary thrombosis in antiphospholipid syndrome: a case report. Cureus. 2019;11(9):e5727. https://doi.org/10.7759/cureus.5727
33. Karakasis P., Lefkou E., Pamporis K. et al. Risk of subclinical atherosclerosis in patients with antiphospholipid syndrome and subjects with antiphospholipid antibody positivity: a systematic review and meta-analysis. Current Problems in Cardiology. 2023;48(6):101672. https://doi.org/10.1016/j.cpcardiol.2023.101672
34. Knight J.S., Branch D.W., Ortel T.L. Antiphospholipid syndrome: advances in diagnosis, pathogenesis, and management. BMJ. 2023;380:e069717. http://dx.doi.org/10.1136/bmj 2021 069717
35. National guidelines for the diagnosis and treatment of diseases of the arteries of the lower extremities. Association of Cardiovascular Surgeons of Russia, Russian Society of Angiologists and Vascular Surgeons, Russian Society of Surgeons, Russian Society of Cardiology, Russian Association of Endocrinologists. — Moscow, 2019. — 89 p. (In Russ.). https://www.angiolsurgery.org/library/recommendations/2019/recommendations_LLA_2019.pdf (18.07.2023)
36. Tektonidou M.G., Andreoli L., Limper M., et al. EULAR recommendations for the management of antiphospholipid syndrome in adults Ann Rheum Dis 2019;78:1296–1304. https://doi.org/10.1136/annrheumdis-2019-215213
37. Bala M.M., Celinska-Lowenho M., Szot W. et al. Antiplatelet and anticoagulant agents for secondary prevention of stroke and other thromboembolic events in people with antiphospholipid syndrome. Cochrane Database Syst Rev. 2020;10:CD012169. https://doi.org/10.1002/14651858.CD012169.pub3
38. Zuily S., Cohen H., Isenberg D. et al. Use of direct oral anticoagulants in patients with thrombotic antiphospholipid syndrome: Guidance from the Scientific and Standardization Committee of the International Society on Thrombosis and Haemostasis. J Thromb Haemost. 2020;18(9):2126-2137. https://doi.org/10.1111/jth.1
39. Bajic Z., Sobot T., Skrbic R. et al. Homocysteine, vitamins b6 and folic acid in experimental models of myocardial infarction and heart failure – how strong is that link? Biomolecules. 2022;12:536. https://doi.org/10.3390/biom12040536
40. Clinical guidelines. Ischemic stroke and transient ischemic attack in adults. Year of approval: 2021. (In Russ.) https://cr.minzdrav.gov.ru/schema/171_2 (18.07.2023)
41. Shoji K., Yanishi K., Wakana N. et al. Acute coronary syndrome with large thrombus successfully managed with no-stenting revascularization based on intravascular imaging in a patient with hyperhomocysteinemia: a case report. Med Case Rep. 2020;14(1):214. https://doi.org/10.1186/s13256-020-02531-5
42. Varlamos C., Pappas C., Kiouri E. et al. Hyperhomocysteinemia as the only risk factor in a young man presenting with ST-elevation myocardial infarction. J Cardiol Cases. 2020;23(3):112-114. https://doi.org/10.1016/j.jccase.2020.10.004
43. Clinical guidelines. Violation of the metabolism of sulfur-containing amino acids (homocystinuria). Year of approval: 2022. (In Russ.) https://cr.minzdrav.gov.ru/schema/483_2 (18.07.2023)
44. Morris A.A.M., Kožich V., Santra S. et al. Guidelines for the diagnosis and management of cystathionine beta-synthase deficiency. J Inherit Metab Dis. 2017;40:49-74. https://doi.org/10.1007/s10545-016-9979-0
45. Boushey C.J., Beresford S.A., Omenn G.S., Motulsky A.G. A quantitative assessment of plasma homocysteine as a risk factor for vascular disease. Probable benefits of increasing folic acid intakes. JAMA. 1995;274(13):1049-1057. https://doi.org/10.1001/jama.1995.03530130055028
46. Homocysteine Studies Collaboration. Homocysteine and risk of ischemic heart disease and stroke: a meta-analysis. JAMA 2002; 288:2015–2022. https://doi.org/10.1001/jama.288.16.2015
47. Sharma A., Rawat A., Hivre M. et al. The impact of high homocysteine on coronary atherosclerosis and hdl function in patients with medium Hdl level. Journal of Pharmaceutical Negative Results. 2023;14(2):2712- 2715. https://doi.org/10.47750/pnr.2023.14.S02.318
48. Werida, R.H., Omran, A. and El-Khodary, N.M., 2021. Sortilin and homocysteine as potential biomarkers for coronary artery diseases. Int J Gen Med. 2021;14:6167-6176. https://doi.org/10.2147/IJGM. S324889
49. Sidney S., Siscovick D.S., Petitti D.B. et al. Myocardial infarction and use of low-dose oral contraceptives. a pooled analysis of 2 US studies. Circulation. 1998;98(11):1058-1063. https://doi.org/10.1161/01. CIR.98.11.1058
50. Weill A., Dalichampt M., Raguideau F. et al. Low dose oestrogen combined oral contraception and risk of pulmonary embolism, stroke, and myocardial infarction in five million French women: cohort study. BMJ. 2016;353:i2002. https://doi.org/10.1136/bmj.i2002
51. National medical criteria for the acceptability of contraceptive methods. Adapted from WHO Medical Eligibility Criteria for Contraceptive Use, 5th edition, 2015. Moscow, 2023 (In Russ.) https://phlebounion.ru/files/uploads/News/files/2023%20Национальные%20критерии%20приемлемости%20контрацепции%202023.pdf (18.07.2023)
52. Visseren F.L.J., Mach F., Smulders Y.M., et al.; ESC National Cardiac Societies; ESC Scientific Document Group. 2021 ESC Guidelines on cardiovascular disease prevention in clinical practice. Eur Heart J. 2021;42(34):3227-3337. https://doi.org/10.1093/eurheartj/ehab484
53. Kayikcioglu M., Ozkan H.S., Yagmur B. Premature myocardial infarction: a rising threat. Balkan Med J. 2022;39(2):83-95. https://doi.org/10.4274/balkanmedj.galenos.2022-2-19
54. Singh A., Collins B.L., Gupta A. et al. Cardiovascular risk and statin eligibility of young adults after an MI: Partners YOUNG-MI Registry. J Am Coll Cardiol. 2018;71:292–302. https://doi.org/10.1016/j.jacc.2017.11.007
55. Bucholz E.M., Strait K.M., Dreyer R.P. et al. Sex differences in young patients with acute myocardial infarction: a VIRGO study analysis. Eur Heart J Acute Cardiovasc Care. 2017;6(7): 610–622. https://doi.org/10.1177/2048872616661847
Review
For citations:
Zykov M.V., Barbarash O.L. Myocardial infarction in young patients. Is everything so obvious? Eurasian heart journal. 2024;(1):108-115. (In Russ.) https://doi.org/10.38109/2225-1685-2024-1-108-115
Views:
962
Email this article 
