title: [Acute myocardial infarction in young patients--severe failures in the system of acute and secondary care].
abstract: BACKGROUND
  The incidence of cardiovascular (CV) diseases and acute myocardial infarction (AMI) in Czech Republic is de-clining. In spite of this in a proportion of patients AMI occurs in young age. The aim of our project was to assess the character of risk factors, precipitating diseases and the quality of care in young AMI survivors.
  
  
  METHODS
  We included 132 patients (97 men and 35 women) in whom AIM with ST elevations occurred before age of 45 years in men and age of 50 years in women. Several results were compared to a control group composed of 84 healthy volunteers of comparable age. We assessed the course of the disease, extent of coronary involvement, subsequent therapy and control of risk factors after 3 years from the index event.
  
  
  RESULTS
  Smoking represented the main risk factor - 85% patents were active smokers at the time of AMI and 9% were former smokers, 64% patients had a positive family history of CV disease. We found a higher prevalence of dyslipidemia history in men. In spite of high rate of statin use, laboratory examination during follow-up revealed higher triglyceride values and low levels of HDL-cholesterol in both genders. All together 23% of patients had a history of provoking underlying disease or precipitating factors (inflammatory diseases, malignancies, combined thrombophilias, drug abuse). In total 95% of patients underwent coronary angiography during the acute phase of AMI, the median time from pain onset to intervention was 9 hours. Most patients had single vessel disease, 14% had even coronary angiogram without clinically significant stenosis. The subsequent care was satisfactory concerning the rate of drug prescriptions. However, target lipid values were not reached in 78% patients and blood pressure targets in 37%.
  
  
  CONCLUSIONS
  In patients who suffered AMI in young age, risk factors are dominated by smoking and positive family history of CV diseases. One fifth of patients suffer from other underlying disease (inflammatory disease, malignancies, combined thrombophilia) or have another precipitating factor (febrile disease, drug abuse). The acute care seems unsatisfactory due to late arrival of most patients to catheterization laboratories (underestimation of the disease, incorrect initial diagnosis). Subsequent therapy is well composed but lacks in intensity.
authors.affiliation: II interní klinika--klinika kardiologie a angiologie 1. lékarské fakulty UK a VFN Praha.
authors.forename: G
authors.initials: G
authors.lastname: Dostálová
authors.forename: J
authors.initials: J
authors.lastname: Bělohlávek
authors.forename: L
authors.initials: L
authors.lastname: Vítek
authors.forename: L
authors.initials: L
authors.lastname: Muchová
authors.forename: M
authors.initials: M
authors.lastname: Skvařilová
authors.forename: D
authors.initials: D
authors.lastname: Karetová
authors.forename: K
authors.initials: K
authors.lastname: Jirátová
authors.forename: J
authors.initials: J
authors.lastname: Kvasnička
authors.forename: D
authors.initials: D
authors.lastname: Vondráková
authors.forename: O
authors.initials: O
authors.lastname: Toman
authors.forename: A
authors.initials: A
authors.lastname: Linhart
mesh_terms: D000328:Adult; D017023:Coronary Angiography; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D012307:Risk Factors; D055502:Secondary Prevention