title: Risk factors for acute non-ST-segment elevation myocardial infarction in a population sample of predominantly African American patients with chest pain and normal coronary arteries.
abstract: BACKGROUND
  We sought to investigate the relationship between echocardiographic left ventricular hypertrophy (LVH) and acute non-ST-elevation segment myocardial infarction (NSTE-MI) in patients with chest pain and angiographically normal coronary arteries.
  
  
  METHODS
  Retrospective analysis of patients admitted for acute chest pain in a large urban hospital serving predominantly African American patients.
  
  
  RESULTS
  131 (of 700) patients had normal coronary arteries or only minimal luminal irregularities (ie, <10% luminal narrowing) on cardiac angiography and available cardiac biomarker data to define the presence or absence of MI. Mean age was 53 +/- 10 years, 76% were African Americans, 88% had a history of hypertension (49% uncontrolled) and 74% had LVH by echocardiography. Of these 131 patients, 22 (17%) had an acute NSTE-MI by creatine kinase MB criteria. The mean systolic blood pressure (BP) was significantly higher in patients with NSTE-MI compared with non-NSTE-MI group (156 +/- 30 vs 143 +/- 25 mm Hg, P=.04). Patients with NSTE-MI were more likely to have LVH (95% vs 70%, P=.03). NSTE-MI was present in 22% of patients with LVH compared with 3% without LVH (P=.02). The in-hospital course of NSTE-MI patients with LVH was not benign: 19% had persistent angina and positive stress thallium suggestive of recurrent myocardial ischemia and 48% had congestive heart failure. The results of multivariable model after adjusting for selected variables revealed that these two preexisting conditions were independently associated with NSTE-MI: LVH (OR=4.0, CI 1.06-10.05) and elevated systolic BP (OR=3.7, CI 1.01-10.64).
  
  
  CONCLUSIONS
  These findings provide preliminary evidence that LVH and uncontrolled hypertension predispose to NSTE-MI in this patient group.
authors.affiliation: Division of Cardiology, Morehouse School of Medicine, Atlanta, GA 30310-1495, USA.
authors.forename: Rigobert
authors.initials: R
authors.lastname: Lapu-Bula
authors.forename: Anekwe
authors.initials: A
authors.lastname: Onwuanyi
authors.forename: Marie-Vero
authors.initials: MV
authors.lastname: Bielo
authors.forename: Orlando
authors.initials: O
authors.lastname: Deffer
authors.forename: Alexander
authors.initials: A
authors.lastname: Quarshie
authors.forename: Ernest
authors.initials: E
authors.lastname: Alema-Mensah
authors.forename: Jo Ann
authors.initials: JA
authors.lastname: Cross
authors.forename: Adefisayo
authors.initials: A
authors.lastname: Oduwole
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ofili
mesh_terms: D000328:Adult; D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D002637:Chest Pain / Q000209:etiology; D017023:Coronary Angiography; D003331:Coronary Vessels / Q000473:pathology; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000208:ethnology; D017379:Hypertrophy, Left Ventricular / Q000150:complications* / Q000000981:diagnostic imaging / Q000208:ethnology; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000208:ethnology*; D012189:Retrospective Studies; D012307:Risk Factors