MYOCARDIAL-INFARCTION IN MEN AGED 40 YEARS OR LESS - A PROSPECTIVE CLINICAL-ANGIOGRAPHIC STUDY

Hypothesis: The study was undertaken to characterize acute myocardial infarction (AMI) in young patients. Methods: In all, 108 consecutive M editerranean patients with AMI (102 men and 6 women), aged less than o r equal to 40 years, were prospectively included in this study over a period of 6.5 years. Coronary angiography was carried out within the f irst month and data from these patients with normal or diseased corona ry arteries were compared. Clinical features, risk factors, and in-hos pital and late morbidity and mortality were evaluated. Results: Young patients with AMI represent 4.1% of the 2,644 patients admitted becaus e of definite AMI during this period. The most common risk factors wer e cigarette smoking (94.5%) and hypercholesterolemia (48%). Location o f the AMI was anterior in 37%, inferior in 57.5%, and non-Q in 5.5%. A history of previous angina was present in 42.5% of the patients, incl uding all seven patients with previous myocardial infarction (6.5%). H owever, in 52% of the patients the anginal episodes started in the wee k prior to the AMI. In-hospital mortality and mortality during a mean follow-up of 41 +/- 23 months were 3.7 and 3.8%, respectively. The Kap lan-Meier actuarial curve assessed on 97 of 104 survivors was 100 and 94% at 1 and 5 years, respectively. Coronary arteries were angiographi cally normal in 17 (20%) of 87 survivors. Compared with young patients who had obstructive lesions, this subset had a lower age and fewer ri sk factors, reinfarction (p<0.05), and late angina (p<0.01), but devel opment of congestive heart failure and survival were similar in both g roups. Conclusion: These data suggest that young patients with AMI are very frequently heavy smokers, have a high incidence of angiographica lly normal coronary arteries, and that the short- and long-term progno sis is excellent.