NORMAL ANGIOGRAM AFTER MYOCARDIAL-INFARCTION IN YOUNG-PATIENTS - A PROSPECTIVE CLINICAL-ANGIOGRAPHIC AND LONG-TERM FOLLOW-UP-STUDY

This is an observational study in which we compared the clinical chara cteristics and the long-term course of young patients having acute myo cardial infarction and angiographically normal coronary arteries and y oung patients showing significant coronary artery disease. In 87 patie nts aged less than or equal to 40 years who suffered an acute myocardi al infarction, enrolled in a prospective study over a period of 6.5 ye ars, coronary anatomy was determined by angiography within a month of admission. The risk factors, clinical data, ventricular function and t he long-term outcome were compared between patients with normal angiog rams (Group 1, n=12) and patients with coronary artery disease (Group 2, n=75). Patients in Group 1 had a lower number of risk factors assoc iated with them (17% vs. 64% with >1 risk factor, P<0.005), were young er (32+/-5 vs. 36+/-4, P<0.01), lighter smokers (25% vs. 55% for great er than or equal to 2 packs per day, P<0.05), had less frequent hypert ension (0 vs. 25%, P<0.05), hypercholesterolemia (17% vs. 52%, P=0.02) and had a lower mean total cholesterol level (201+/-42 vs. 245+/-60 m g/100 ml, P<0.05) than patients in Group 2. They also had a more commo n onset of their infarction during heavy physical exertion (67% vs. 17 %, P<0.001). A history of previous myocardial infarction, infarct loca tion, global left ventricular function and regional wall motion were s imilar in both groups. After a mean follow-up period of 41+/-23 months , no patient died or had a second myocardial infarction in Group 1, an d 4 patients had died in Group 2. The appearance of angina, less frequ ent in Group 1 than Group 2, tended to correlate with the extension of the coronary artery disease. We concluded that young patients with my ocardial infarction have good prognosis irrespective of the coronary a natomy, although patients with normal coronary angiograms had less ris k factors and less frequent new ischaemic events. (C) 1997 Elsevier Sc ience Ireland Ltd.