Endothelial dysfunction in young patients with acute ST-elevation myocardial infarction.
Endothelial dysfunction may be particularly important in the pathogenesis of young patients with acute myocardial infarction (AMI), because they have different clinical characteristics compared with older patients. We investigated endothelial function in relation to AMI in this young age group. From January 2005 to March 2008, 29 of 31 consecutive patients with acute ST-elevation myocardial infarction (STEMI) who were <40 years old and received direct percutaneous coronary intervention (PCI) were enrolled in the study. We compared the coronary risk factors and flow-mediated vasodilation (FMD) in the brachial artery between the acute STEMI patients and 29 age- and gender-matched controls that did not have AMI. Baseline brachial artery diameter and responses to glyceryl trinitrate were similar between the two groups. In contrast, FMD was significantly lower in the young acute STEMI group than in the control (3.47 ± 4.08 vs. 7.45 ± 4.67%, p = 0.001) and correlated with the Thrombolysis in Myocardial Infarction (TIMI) risk score. The impaired FMD in the acute STEMI group was independent of smoking, hyperlipidemia, hypertension, nitrate use, or body mass index. In multiple logistic regression analysis, only FMD and age, not traditional cardiovascular risk factors, were found to be significantly associated with acute STEMI (odds ratio = 0.75, 95% CI 0.63-0.90, p < 0.01). In conclusion, independent of conventional risk factors, severe endothelial dysfunction occurs in young acute STEMI patients and correlates with TIMI score. In addition to age, impaired FMD is the only significant factor associated with acute STEMI in this young population.
Division of Cardiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123 Tapei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan, ROC.
Shyh-Ming
SM
Chen
Tzu-Hsien
TH
Tsai
Chi-Ling
CL
Hang
Hon-Kan
HK
Yip
Chi-Yuan
CY
Fang
Chiung-Jen
CJ
Wu
Gary Bih-Fang
GB
Guo
D000328:Adult; D017668:Age of Onset; D015906:Angioplasty, Balloon, Coronary; D001916:Brachial Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D004730:Endothelium, Vascular / Q000000981:diagnostic imaging / Q000503:physiopathology*; D005260:Female; D006801:Humans; D006940:Hyperemia / Q000503:physiopathology; D017078:Laser-Doppler Flowmetry; D016015:Logistic Models; D008297:Male; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000628:therapy; D016017:Odds Ratio; D018570:Risk Assessment; D012307:Risk Factors; D013624:Taiwan; D018617:Ultrasonography, Doppler, Pulsed; D014664:Vasodilation