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Abstract
ABSTRACT
Introduction: Acute coronary syndrome in youngers than 45 years old constitutes a clinical condition with specific characteristics that tells it apart from older patients because the poor symptomatology previous to the origin of the acute coronary syndrome and the presence of peculiars risk factors such as connective tissue disorders, hypercoagulability states and the drugs intake, leads to lesser complications and better prognosis. Objective: characterize the acute coronary syndrome in young adults admitted at the Cardiology and Surgery Cardiovascular’s Institute between the years 2013 and 2014. Materials and Methods: Descriptive and transverse study with 99 patients under 45 years old who had acute coronary syndrome. There were analyzed clinical variables, diagnostic and therapeutic strategies. Results: The mean age was 42 years and the masculine sex was predominant. Smoking, arterial hypertension and dyslipidemia were the risk factors more common. The typical pain was in the 70.7% of patients. Electrocardiographic disorders of the inferior region (33.3%) and previous (22.2%) were the more frequents. The normal ejection fraction of the left ventricle (22.2%) predominated in the one vessel disease. The hypokinesia (48.5%) and akinesia (26.3%) predominated in this syndrome. The most responsible arteries were the descending previous (40.4%) and the right coronary (28.3%). The coronary percutaneous intervention was the procedure more made in acute coronary syndrome with ST segment elevation. Conclusions: The minimum extension of the coronary disease justified the conservation of the ventricular function, the segmentary hypokinesia and the softly percent of complications. The coronary percutaneous intervention constituted the strategy of re-perfusion more used in the acute coronary syndrome with elevation of the segment ST. MÉD UIS. 2015;28(3):281-90.
Key words: Young adult. Acute coronary syndrome. Systolic volume. Segmentary motility. Percutaneous coronary intervention
References
Instituto Nacional de Estadística. Defunciones según la causa de muerte. Madrid: INE; 2009 [actualizado Jul 2011]. Disponible en: http://www.ine.es
Widimsky P, Zelizko M, Jansky P, Tousek F, Holm F, Aschermann M. The incidence, treatment strategies, outcomes of acute coronary syndromes in the “reperfusión network” of different hospital types in the Czech Republic: results of the Czech evaluation of acute coronary syndromes in hospitalized patients
(CZECH) registry. Int J Cardiol. 2007; 119:212-9.
Widimsky P, Wijns W, Fajadet J, de Belder M, Knot J, Aaberge L et al. Reperfusion therapy for ST elevation acute myocardial infarction in Europe: description of the current situation in 30 countries. Eur Heart J. 2010; 31:943-57.
Ford ES, Greenlund KJ, Hong Y. Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States. Circulation. 2012; 125(8):987-95.
McManus DD, Gore J, Yarzebski J, Spencer F, Lessard D, Goldberg RJ. Recent trends in the incidence, treatment, and outcomes of patients with STEMI and NSTEMI. Am J Med. 2011; 124:40-
Dégano IR, Elosua R, Marrugat J. Epidemiología del síndrome coronario agudo en España: estimación del número de casos y la tendencia de 2005 a 2049. Rev Esp Cardiol. 2013; 66(6):472-548.
Kauffmann QR, et al. Infarto agudo del miocardio: el factor tiempo. Rev Méd Chile. 2008; 136:1095-97.
Pinho AL. The two Brazils and treatment of acute myocardial infarction. São Paulo Bras Cardiol. 2009; 93(2).
Ministerio de Salud Pública. Anuario estadístico de salud 2014 La Habana: MINSAP; 2015 [Consultado 2015 jul 19]. Disponible en: http://bvscuba.sld.cu/anuario-estadistico-de-cuba/2014/
Meikle PJ, Wong G, Tsorotes D, Barlow CK, Weir JM, Christopher MJ et al. Plasma lipidomic analysis of stable and unstable coronary artery disease. Arterioscler Thromb Vasc Biol. 2011; 31(11):2723-32.
Rizo GO, Ramírez JI, Gómez YC. Enfoque actual sobre la fisiopatología del síndrome coronario agudo. Rev cubana med. 2009; 48(3):71-87.
Sambola A, Fuster V, Badimon JJ. Papel de los factores de riesgo en la trombogenicidad sanguínea y los síndromes coronarios agudos. Rev esp cardiol. 2003; 56(10):1001-9.
Nicholls S.J, Tuzcu E.M, Kalidindi S, Wolski K, Moon KW, Sipahi I et al. Effect of diabetes on progression of coronary atherosclerosis and arterial remodeling: a pooled analysis of 5 intravascular ultrasound trials. J Am Coll Cardiol. 2008; 52(4):255-62.
Xu Y, Ma LL, Zhou C, Zhang FJ, Kong FJ, Wang WN et al. Hypercholesterolemic myocardium is vulnerable to ischemia- reperfusion injury and refractory to sevoflurane-induced protection. PLoS One. 2013; 8(10):e76652.
Hamm CW, Bassand JP, Agewall S, Bax J, Boersma E, Bueno H et al. Guía de práctica clínica de la ESC para el manejo del síndrome coronario agudo en pacientes sin elevación persistente del segmento ST. Rev Esp Cardiol. 2012; 65(2):173.e1-e55.
Reichlin T, Hochholzer W, Bassetti S, Steuer S, Stelzig C, Hartwiger S, et al. Early diagnosis of myocardial infarction with sensitive cardiac troponin assays. N Engl J Med. 2009; 361:858-67.
Giannitsis E, Becker M, Kurz K, Hess G, Zdunek D, Katus HA. High-sensitivity cardiac troponin T for early prediction of evolving non-ST-segment elevation myocardial infarction in patients with suspected acute coronary syndrome and negative troponin results on admission. Clin Chem. 2010; 56(4):642-50.
Correa AJ, Macías M, Robledo R, Ramírez JF, Hernández JA. El Infarto agudo del miocardio en pacientes jóvenes. Med Int Mex. 2003; 19(1):3-7.19. Stary HC. Evolution and progression of atherosclerotic lesions in coronary arteries of children and young adults. Atherosclerosis. 1989; 9(1 Suppl): 19-32.
Stary HC. Evolution and progression of atherosclerotic lesions in coronary arteries of children and young adults. Atherosclerosis. 1989; 9(1 Suppl): 19-32.
Fuster V, Badimon L, Badimon JJ, Chesebro JH. The pathogenesis of coronary artery disease and the acute coronary syndromes. N Engl J Med. 1992; 326 (5) :310-18.
Siwach SB, Singh H, Sharma D, Katyal VK. Profile of young acute myocardial Infarction in Harayana. J Assoc Physicians India. 1998; 46(5):424–26.
Ueda Y, Okada K, Ogasawara N, Oyabu J, Hirayama A, Kodama K. Acute myocardial infarction without disrupted yellow plaque in young patients below 50 years old. J Interv Cardiol. 2007; 20(3):177–81.
Chen YL, Bhasin A, Youssef AA, Wu CJ , Yang CH, Hsieh YK, et al. Prognostic factors and outcomes in young Chinese patients with acute myocardial infarction undergoing primary coronary angioplasty. Int Heart J. 2009; 50(1):1–11.
Teixeira M, Sa I, Mendes JS, Martins L. Acute coronary syndrome in young adults. Rev Port Cardiol. 2010; 29(6):947–55.
Schoenenberger AW, Radovanovic D, Stauffer JC, Windecker S, Urban P, Niedermaier G, et al. Acute coronary syndromes in young patients: presentation, treatment and outcome. Int J Cardiol. 2011; 148(3):300–4.
Marcos Rodríguez E, Antonio Cabrera DL, Alemán Sánchez JJ, Miranda Montero S, Pimienta González R, Couto Comba P et al. Pronóstico y factores asociados al Síndrome Coronario Agudo en jóvenes. Rev Esp Cardiol. 2012; 65 (Supl 3):236.
Belén Díaz A, Belén Rubio A, Molina Martín de Nicolás J, García-Aranda Domínguez B, Granda Nistal C, Mayordomo Gómez S et al. Estudio descriptivo del síndrome coronario agudo en el paciente joven. Rev Esp Cardiol. 2012; 65 (Supl 3):193.
Marín F, Ospina LF. Infarto agudo del miocardio en adultos jóvenes menores de 45 años. Rev Col Cardiol. 2004;11(4):193-204.
Kallen AN, Pal L. Cardiovascular disease and ovarian function. Curr Opin Obstet Gynecol. 2011; 23(4):258-67.
Yang XP and Reckelhoff JF. Estrogen, hormonal replacement therapy and cardiovascular disease. Curr Opin Nephrol Hypertens. 2011; 20(2):133–38.
Yang WX, Yang Z, Wu YJ, Qiao SB, Yang YJ, Chen JL. Factors associated with coronary artery disease in young population (age≤40): analysis with 217 cases. Chin Med Sci J. 2014; 29(1):38-42.
Chua SK, Hung HF, Shyu KG, Cheng JJ, Chiu CZ, Chang CM et al. Acute ST-elevation myocardial infarction in young patients: 15 years of experience in a single center. Clin Cardiol. 2010; 33(3):140-8.
Tisminetzky M, McManus D, Gore JM, Yarzebski J, Coles A, Lessard D, et al. 30-years trends in patients characteristics, treatment practices, and long-term outcomes of adults aged 35 to 45 years hospitalized with acute myocardial infarction. Am J Cardiol. 2014; 113(7):1137-41.
Díaz Águila O, Díaz Castro O, Díaz Águila NO, Valdés Manresa L, Yera Alós I, Carpio García V, et al. Caracterización de los factores de riesgo vascular en pacientes adultos. CorSalud. 2013; 5(3):269-73.
Rubiera R, Lara A, Iván N, Palacio H, Vignier D. Síndrome coronario agudo. Caracterización clínico epidemiológica. A propósito de nuestro primer año. Rev Cub Med Int Emerg. 2009; 8(3).
Lamm G, Auer J, Weber T, Berent R, Lassnig E, Eber B. Cardiovascular risk factor profiles and angiography results in young patients. Acta Med Austriaca. 2003; 30(3):72-5.
Garcia-Castillo A, Jerjes-Sánchez C, Martínez-Bermúdez P, Azpiri-López JR, Autrey Caballero A, Martínez Sánchez C, et al. Registro Mexicano de Síndromes Coronarios Agudos: RENASICA II Mexican Registry of Acute Coronary Syndromes. Arch Cardiol Méx. 2005; 75(s):6-19.
Alcántara A, Pérez M, Martínez D. Comportamiento del síndrome coronario agudo en menores de 45 años en el hospital docente Padre Billini. Rev Méd Domin. 2010; 71(3):83-6.
Moreno E, Pérez A, Herrero I, Usón T, Placer L. Características clínico-funcionales en pacientes fumadores con infarto agudo de miocardio y su situación a los 5 años. Prev Tab. 2006; 8(4):148-55.
García LM, Ramírez JI, Llanes MC, Trujillo JA, Alegret M. Estudio de la cardiopatía isquémica en pacientes menores de 45 años. CorSalud. 2009; 1(4):4-13.
Puricel S, Lehnerb C, Oberhänslia M, Rutz T, Tognib M, Stadelmanna M, et al. Acute coronary syndrome in patients younger than 30 years - aetiologies, baseline characteristics and long-term clinical outcome. Swiss med. wkly. 2013;
(w13816):2-8.
Biswas PK, Dabiswas A, Roy S, Roy D, Biswas A, Chatterjee SS, et al. Risk Factors and angiography profile of coronary artery disease in young. J Indian Med Assoc. 1995; 93(3):90-4.
Suárez Cuervo A, Avanzas Fernández P, Pascual Calleja I, del Valle Fernández R, Torres Saura F, Benito Martín EM et al. ¿Hay alguna característica especial en los pacientes menores de 40 años que presentan un síndrome coronario agudo con elevación del ST? Rev Esp Cardiol. 2012; 65(3):190-1.
San Román JA, Candell-Riera J, Arnold R, Sánchez P, Aguadé-Bruix S, Bermejo J, Revilla A, et al. Análisis cuantitativo de la función ventricular izquierda como herramienta para la investigación clínica. Fundamentos y metodología. Rev Esp
Cardiol. 2009; 62(5):535-51.
Flachskampf F, Schmid M, Rost C, Achenbach S, de Maria AN, Daniel WG. Cardiac imaging after myocardial infarction. Eur Heart J. 2011; 32(3):272-83.
Gierlotka M, Gasior M, Wilczek K, Hawranek M, Szkodzinski J, Paczek P et al. Reperfusion by primary percutaneous coronary intervention in patients with ST-segment elevation myocardial infarction within 12 to 24 hours of the onset of symptoms (from a prospective national observational study [PL-ACS]). Am J
Cardiol. 2011; 107:501-8.
Zimmerman FH, Cameron A, Fisher LL, Grace NG. Myocardial Infarction in Young Adults: Angiographic Characterization, Risk Factors and Prognosis (Coronary Artery Surgery Study Registry). J Am Coll Cardiol. 1995; 26(3):654-61.