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Risk Factors, Clinical Features of the Course of Myocardial Infarction and Treatment of Young Patients Based on Two Hospital Registries

https://doi.org/10.20996/1819-6446-2020-04-01

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Abstract

Aim. To identify specific risk factors and features of the course of myocardial infarction (MI) in young patients.

Material and methods. The study design is based on a comparison of observation data for patients of different ages from the Russian RECORD-3 registry (n=2359) and the registry of acute coronary syndrome of the Kemerovo city in 2015 (n=1343). The clinical and anamnestic portrait was determined, the frequency of hospital complications and the “hard” endpoints were evaluated.

Results. Young patients with myocardial infarction (MI) according to RECORD-3 are more often male smokers (p=0.001) with a heredity in cardiovascular pathology (p=0.034), who have an uncomplicated STEMI upon admission to the hospital, and are sent for coronary angiography with stenting (p=0.001), without prescribing statins in the primary and secondary prevention (p=0.050 and p=0.016, respectively). There were no differences with other age groups by endpoints a year later; during the current hospitalization, young patients less often died (p=0.001) or had a relapse of MI (p=0.011). Young patients with MI from Kemerovo were also mostly male smokers (p=0.001), who more often had a history of chronic kidney disease, chronic heart failure, and lipid metabolism disorders (p=0.001), who admitted to the hospital with uncomplicated STEMI, actively undergoing thrombolytic therapy and endovascular diagnosis and treatment (p=0.001). However, it should be noted that these patients were less likely to receive aspirin (p=0.015), dual antiplatelet therapy (p=0.003), angiotensin converting enzyme (ACE) inhibitors (p=0.040) and statins (p=0.001). Moreover, in young patients with MI, deficiency of high density lipoproteins (p=0.005) was more often found in the absence of very high values of low density lipoproteins (p=0.001). Among the complications of inpatient treatment, it should be noted a tendency to bleeding (p=0.001). One year after referent MI a high proportion of repeated non-fatal MI (p=0.005) and deaths (p=0.001) were observed. A comparison of the registries showed that young patients from Kemerovo were more likely to have STEMI (p=0.032), they were more likely to have stenting (p=0.004), they were more often diagnosed with chronic renal and heart failure (p=0.001), and more often ACE inhibitors was prescribed (p=0.017), and MI during hospitalization was more often complicated by bleeding (p=0.003).

Conclusion. From 1.7 to 2.4% of all MI occurs in young patients. The most frequent version of the debut is STEMI. The leading factors of cardiovascular risk in such patients are the male gender, active smoking, a hereditary history of cardiovascular diseases, low cholesterol of high density lipoproteins with insufficient statins prevention. In young patients of the Kemerovo registry, chronic heart failure and chronic kidney disease were more often observed, and ACE inhibitors were prescribed, hospitalization was often accompanied by bleeding. In a young age differences in the frequency and structure of outcomes in one year after referent MI were not found when comparing registries.

About the Authors

O. L. Barbarash
Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University
Russian Federation

Olga L. Barbarash – MD, PhD, Professor, Corresponding Member of the Russian Academy of Sciences, Director of Research Institute for Complex Issues of Cardiovascular Diseases; Head of Chair of Cardiology and Cardiovascular Surgery, Kemerovo State Medical University

Sosnoviy bulv. 6, Kemerovo, 650002, 

Voroshilova ul. 22A, Kemerovo, 650029

 



D. Yu. Sedykh
Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo Regional Cardiology Dispensary
Russian Federation

Darya Yu. Sedykh – MD, PhD, Researcher, Laboratory of Pathophysiology of Multivessel Coronary Artery Disease and Polyvascular Disease, Research Institute for Complex Issues of Cardiovascular Diseases; Сardiologist, Kemerovo Regional Clinical Cardiology Dispensary

Sosnoviy bulv. 6, Kemerovo, 650002



I. S. Bykova
Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo Regional Cardiology Dispensary
Russian Federation

Irina S. Bykova – MD, PhD, Junior Researcher, Laboratory of Pathophysiology of Multivessel Coronary Artery Disease and Polyvascular Disease, Research Institute for Complex Issues of Cardiovascular Diseases; Cardiologist, Kemerovo Regional Clinical Cardiology Dispensary

 Sosnoviy bulv. 6, Kemerovo, 650002 



V. V. Kashtalap
Research Institute for Complex Issues of Cardiovascular Diseases; Kemerovo State Medical University
Russian Federation

Vasiliy V. Kashtalap – MD, PhD, Head of Laboratory of Pathophysiology of Multivessel Coronary Artery Disease and Polyvascular Disease, Research Institute for Complex Issues of Cardiovascular Diseases; Associate Professor, Chair of Cardiology and Cardiovascular Surgery, Kemerovo State Medical University

Sosnoviy bulv. 6, Kemerovo, 650002, 

Voroshilova ul. 22A, Kemerovo, 650029



A. D. Erlich
Moscow City Clinical Hospital named after N.E. Bauman
Russian Federation

Alexey D. Erliсh – MD, PhD, Head of Department of Cardiological Resuscitation

Gospitalnaya pl. 2, Moscow, 111020 



References

1. Artamonova G.V., Maksimov S.A., Tabakaev M.V. Trends in mortality of the working-age population from diseases of the circulatory system in the Russian Federation and the Kemerovo region. Health care of the Russian Federation. 2015;59(6):19-24 (In Russ.).

2. Yunyun W., Tong L., Yingwu L., et al. Analysis of risk factors of ST-segment elevation myocardial infarction in young patients. BMC Cardiovasc Disord. 2014;14:179. DOI:10.1186/1471-2261-14-179.

3. Andreenko E.Y., Yavelov I.S., Loukianov М.М., et al. Ischemic Heart Disease in Subjects of Young Age: Current State of the Problem: Prevalence and Cardio-Vascular Risk Factors. Kardiologiia. 2018;58(10):53-8 (In Russ.)

4. Clinical guidelines for the diagnosis and treatment of patients with acute coronary syndrome without ST-segment elevation of the electrocardiogram (part 1). Recommendations of the society of specialists in emergency cardiology. Neotlozhnaya Kardiologiya. 2016;(2):26-62 (In Russ.)

5. Chandrasekhar J., Gill A., Mehran R. Acute myocardial infarction in young women: current perspectives. International Journal of Women’s Health. 2018;10:267-84. DOI:10.2147/IJWH.S107371.

6. Safdar В., Spatz Е.S., Dreyer R.P., et al. Presentation, Clinical Profile, and Prognosis of Young Patients with Myocardial Infarction With Nonobstructive Coronary Arteries (MINOCA): Results From the VIRGO Study. J Am Heart Assoc. 2018;7:e009174. DOI:10.1161/JAHA.118.009174.

7. Ricci B., Cenko E., Vasiljevic Z., et al. Acute Coronary Syndrome: The Risk to Young Women. J Am Heart Assoc. 2017;6:e007519. DOI:10.1161/JAHA.117.007519.

8. DeFilippis A.P., Young R., McEvoy J.W., et al. Risk score overestimation: the impact of individual cardiovascular risk factors and preventive therapies on the performance of the American Heart Association-American College of Cardiology-Atherosclerotic Cardiovascular Disease risk score in a modern multi-ethnic cohort. Eur Heart J. 2017;38:598-608. DOI:10.1093/eurheartj/ehw301.

9. Kozhokar K.G., Urvantseva I.A., Lifshits G.I., et al. Associations of psychosocial indicators with probable hospital mortality on TIMI and GRACE scales in patients with acute coronary syndrome living in conditions of the North. Clinical Practice. 2017;3(31):18-27 (In Russ.)

10. Singh A., Collins B., Qamar A., et al. Study of young patients with myocardial infarction: Design and rationale of the YOUNG-MI Registry. Clin Cardiol. 2017;40(11):955-61. DOI:10.1002/clc.22774.

11. Erliсh A.D. Six-month outcomes in acute coronary syndrome patients included in the registry record3. Russian Journal of Cardiology. 2017;(11):8-14 (In Russ.)

12. Erlich A.D. 12-month outcomes in patients with acute coronary syndrome, included in the Russian registry Record-3. Russian Journal of Cardiology. 2018;3(155):23-30 (In Russ.)

13. Arora S., Stouffer G.A., Kucharska-Newton A.M., et al. Twenty Year Trends and Sex Differences in Young Adults Hospitalized With Acute Myocardial Infarction. The ARIC Community Surveillance Study. Circulation. 2019;139:1047-56.

14. Shukla A.N., Jayaramy A.A., Dhaval D., et al. The Young Myocardial Infarction Study of the Western Indians YOUTH Registry. Glob Heart. 2019;14(1):27-33. DOI:10.1016/j.gheart.2018.12.001.

15. Sedykh D.Y., Neverova N.Y., Vakkosov K.M., et al. Results of 5-year monitoring of patients after myocardial infarction. Siberian Medical Review. 2018;(3): 51-8 (In Russ.) DOI:10.20333/2500136-2018-3-51-58.

16. Luzin V.G., Urvantseva I.A., Shamrin Y.N., et al. Analysis of the influence of risk factors on hospital mortality in patients with acute myocardial infarction after emergency coronary artery bypass surgery. Medical Science and Education of the Urals. 2018;1:55-7 (In Russ.)

17. Sedykh D.Y., Gorbunova E.V., Zykov M.V., et al. Factors associated with the risk of death and hospitalization during the development of recurrent myocardial infarction. Creative Cardiology. 2017;11(2):98-108 (In Russ.)

18. Kosyagin D.O., Zavyrilina P.N., Sedih D.Y., et al. Factors associated with delays in seeking medical care in myocardial infarction. Complex Issues of Cardiovascular Diseases. 2017;(3):104-12 (In Russ.)

19. Ragino Y.I., Kuzminykh N.A., Shcherbakova L.V., et al. Prevalence of coronary heart disease (by e et al. demiological criteria) and its association with lipid and non-lipid risk factors in the Novosibirsk population of 25-45 years. Russian Journal of Cardiology. 2019;(6):78-84 (In Russ.) DOI:10.15829/1560-4071-2019-6-78-84.


For citation:


Barbarash O.L., Sedykh D.Yu., Bykova I.S., Kashtalap V.V., Erlich A.D. Risk Factors, Clinical Features of the Course of Myocardial Infarction and Treatment of Young Patients Based on Two Hospital Registries. Rational Pharmacotherapy in Cardiology. 2020;16(2):250-257. (In Russ.) https://doi.org/10.20996/1819-6446-2020-04-01

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ISSN 1819-6446 (Print)
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