Dr. H.K. Bali - Cardiologist, Chandigarh

Dr. H.K. Bali

Director Cardioloy, Fortis Mohali

Areas of Expertise: Angioplasty, Coronary Intervention

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Clinical and Angiographic Profile of Patients with Acute Myocardial Infarction less than 35 years of Age: emphasis on Newer Risk Factors

Background: Immediate cardiac catheterization (CC) is recommended for ST-elevation myocardial infarction (STEMI) following sudden cardiac arrest (SCA). Guidelines advise urgent CC for SCA patients without-STEMI, at clinician discretion. We examined the clinical and angiographic factors predicting mortality in SCA patients having CC. Methods: Consecutive SCA patients having CC at Liverpool Hospital, Sydney (January 2011-September 2015) were retrospectively analyzed. Patient data were retrieved from hospital records, and angiographic SYNTAX scores (SS) were quantified online. Independent predictors of mortality were derived using multivariate logistic analysis. Results: The study cohort comprised 104 SCA patients; mean age 61±12years, and 79% male. Immediate CC (<2hours post-SCA) was performed in 35% overall. Compared to the without-STEMI subgroup, STEMI patients had more ventricular fibrillation (91 vs 50%; p<0.0001), and higher mean peak serum high-sensitivity troponin-T (8.25±14.7 vs 1.97±6.13 ug/L; p=0.006); in the context of higher median SS (18 vs 6.5; p=0.002) and target-lesion SS (TSS, 10 vs 0; p<0.001). Percutaneous coronary intervention (PCI; 75 vs 23%; p<0.0001) and target vessel revascularization (11 vs 0%; p=0.005) were more frequent for STEMI. All-cause mortality was 39%, at 1.3±1.5years follow-up. Independent mortality predictors were: delayed CC (HR 4.08), serum lactate >7mmol/L (HR 3.47), and TSS (HR 1.05). Conclusions: Elevated serum lactate, TSS, and delayed CC, were predictive of longer-term mortality in SCA patients having CC. Late CC in patients without-STEMI suggests scope for improvement in real-world systems of care. Closer scrutiny of target lesion complexity may aid prognostication in SCA survivors.
 

Jasbir Singh, Sunip Banerjee, Mandeep Bhargava, H.K. Bali. Clinical and Angiographic Profile of Patients with Acute Myocardial Infarction less than 35 years of Age: emphasis on Newer Risk Factors. Indian Heart Journal 2001; 53:568. 

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