Clinical and biochemical factors associated with prognosis after myocardial infarction at a young age

• Published in: Journal of the American College of Cardiology Vol. 24; no. 3; pp. 592 - 599
• Main Authors: Malmberg, Klas, Båvenholm, Peter, Hamsten, Anders
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.09.1994; Elsevier Science
• Subjects: Adult; Age Factors; Biological and medical sciences; Blood Glucose - metabolism; Cardiology. Vascular system; Cohort Studies; Coronary Angiography; Coronary Artery Disease - diagnostic imaging; Coronary heart disease; Death, Sudden, Cardiac - etiology; Fibrinolysis; Follow-Up Studies; Glucose Tolerance Test; Heart; Humans; Hypertriglyceridemia - complications; Insulin - blood; Lipoproteins - blood; Lipoproteins, VLDL - blood; Male; Medical sciences; Multivariate Analysis; Myocardial Infarction - blood; Myocardial Infarction - diagnostic imaging; Myocardial Infarction - mortality; Plasminogen Activator Inhibitor 1 - blood; Prognosis; Proportional Hazards Models; Prospective Studies; Recurrence; Survival Analysis; Triglycerides - blood; Ventricular Function, Left; Human; Prognosis; Infarct; Young adult; Myocardium; Cardiovascular disease; Coronary heart disease; Myocardial disease
• ISSN: 0735-1097; 1558-3597
• DOI: 10.1016/0735-1097(94)90002-7

Objectives. This study examined the effect of metabolic disturbances, hemostatic function, coronary artery disease severity and left ventricular function on the long-term prognosis after myocardial infarction in men <45 years old. Background. Heavy smoking; dyslipoproteinemias involving very low density lipoprotein (VLDL), low density lipoprotein (LDL) and high density lipoprotein (HDL); a family history of premature coronary artery disease; hyperinsulinemic responses to oral and intravenous glucose challenges; and defective fibrinolytic function characterize the young postinfarction patient, but the influence of these features on the long-term prognosis is virtually unknown. Methods. Measurements of hemostatic function and metabolic and angiographic indicators of risk were included in a prospective cohort study of variables predictive of reinfarction, cardiac death and major coronary events within 6 to 9 years in 108 unselected nondiabetic men with a first myocardial infarction before age 45 years. Results. During follow-up, 20 patients had sudden cardiac death, and 53 had a major coronary event (reinfarction, sudden cardiac death, bypass surgery or intervention by catheterization). In multivariate analysis, VLDL and global coronary atherosclerosis score predicted reinfarction; plasma plasminogen activator inhibitor-1 (PAI-1) activity and global coronary stenosis score predicted cardiac death; and VLDL triglyceride levels, global coronary atherosclerosis score and age predicted any major coronary event. Conclusions. This prospective cohort study shows that hypertriglyceridemia, impaired fibrinolytic capacity secondary to plasma PAI-1 activity elevation and extensive coronary artery disease increase the risk of recurrences in men with a first myocardial infarction before age 45 and contribute to the relatively poor long-term prognosis in this patient group.