Risk factors and in-hospital outcome of acute ST segment elevation myocardial infarction in young Bangladeshi adults

BackgroundSouth Asians have a higher overall incidence rate and younger age of onset for acute myocardial infarction (AMI) compared to Western populations. However, limited information is available on the association of preventable risk factors and outcomes of AMI among young individuals in Bangladesh. The aim of this study was to determine the risk factors and in-hospital outcome of AMI among young (age &le;40 years) adults in Bangladesh.MethodsWe conducted a prospective observational study among consecutive 50 patients aged &le;40 years and 50 patients aged &gt;40 years with acute ST Segment Elevation Myocardial Infarction (STEMI) and followed-up in-hospital at the National Institute of Cardiovascular Diseases (NICVD). Clinical characteristics, biochemical findings, diet, echocardiography and in-hospital outcomes were compared between the two groups. Multivariate logistic regression was performed to assess the association between risk factors and in-hospital outcome in young patients adjusting for other confounding variables.ResultsThe mean age of the young and older patient groups was 36.5&thinsp;&plusmn;&thinsp;4.6 years and 57.0&thinsp;&plusmn;&thinsp;9.1 years respectively. Male sex (OR 3.4, 95 % CI 1.2&thinsp;&minus;&thinsp;9.75), smoking (OR 2.4, 95 % CI 1.04&thinsp;&minus;&thinsp;5,62), family history of MI (OR 2.4, 95 % CI 1.11&thinsp;&minus;&thinsp;5,54), homocysteine (OR 1.2, 95 % CI 1.08&thinsp;&minus;&thinsp;1.36), eating rice &ge;2 times daily (OR 3.5, 95 % CI 1.15&thinsp;&minus;&thinsp;10.6) and eating beef (OR 4.5, 95 % CI 1.83&thinsp;&minus;&thinsp;11.3) were significantly associated with the risk of AMI in the young group compared to older group. In multivariate analysis, older patients had significantly greater chance of developing heart failure (OR 7.5, 95 % CI 1.51 to 37.31), re-infarction (OR 7.0, 95 % CI 1.08&thinsp;&minus;&thinsp;45.72), arrhythmia (OR 15.3, 95 % CI 2.69&thinsp;&minus;&thinsp;87.77) and cardiogenic shock (OR 69.0, 95 % CI 5.81&thinsp;&minus;&thinsp;85.52) than the younger group.ConclusionYounger AMI patients have a different risk profile and better in-hospital outcomes compared to the older patients. Control of preventable risk factors such as smoking, unhealthy diet, obesity and dyslipidemia should be reinforced at an early age in Bangladesh.<br /

36. Clinical profile of coronary slow flow phenomena – A cardiac Y syndrome

Coronary slow flow phenomenon (CSFP) is characterized by delayed progression of the contrast medium injected through the coronary tree during Coronary Angiogram (CAG). CSFP is usually observed in patient with various spectrum of Coronary Artery Disease including Acute Coronary Syndrome and Chronic Stable Angina (CSA). The exact pathogenesis of CSFP is unknown, but 80% of patients experience recurrent episodes of typical anginal pain which results in impairment of quality of the life. Endothelial Dysfunction, Inflammation and diffuse atherosclerosis are various proposed pathogenesis of CSFP. CSFP causes significant cardiovascular morbidity due to dynamic ECG changes and symptoms worsening necessitating recurrent hospitalization and they tend to undergo repeated investigations like Coronary Angiogram. Aim: To see clinical characteristics like risk factors and others of coronary slow flow phenomena. Methods: A total of 45 patients over a period of 6 months with Non Obstructive coronaries below the age group of 60 years who presented with Ischemic Heart Disease were studied. Coronary Slow Flow was identified using thrombolysis in myocardial infarction (TIMI) frame count (TFC) method introduced by Gibson. TIMI-2 flow grade (i.e. requiring ⩾3 beats to opacify the vessel) or a corrected TIMI frame count >27 frames have been frequently used. The later is based upon images acquired at 30 frames/second and a correction factor of 1.7 for the LAD Risk factors and profiles of all the patients were studied in detail. Those patients who had Coronary Artery ectasia, coronary aneurysm, ventricular dysfunction, valvular heart disease and connective tissue disorders. were excluded. Results: Out of 45 patients presented with CSFP 95% were males and 5% females with a mean age of 47 years. CSA with Positive Stress Test were 65%, 15% had Unstable Angina and 25% presented with Myocardial Infarction with Positive Troponin I test . Dynamic ECG changes were present in 30% of the cases. Analysing the risk factors, most of the patients had uncontrolled hypertension (75%) and also were smokers (65%). Diabetes was prevalent in 60% of cases and dyslipidemia in 35% of cases. There were no mortalities noted in hospitalized patients. Conclusion: CSFP was prevalent in wide spectrum if Ischemic Heart Disease presenting as CSA and Acute Coronary Syndrome. Most of the patients presented with CSFP were smokers and had uncontrolled Hypertension