Risk Factors and In-hospital Outcome of Young Adults Presented with Acute Myocardial Infarction and Treated with Primary PCI

Background: Acute myocardial infarction (AMI) is often characterised pathologically as the death of cardiomyocytes as a consequence of persistent ischaemia result in an acute imbalance among oxygen supply and demand. Coronary artery disease (CAD) is the leading cause of death worldwide. AMI mainly affects patients older than 40 years of age, however, young can suffer MI. In the developing countries, CAD is becoming an epidemic, where it occurs in younger persons at greater rates. Clinical features and prognosis of young patients tend to vary from those of older individuals. the outcomes of a MI may be especially severe at a young age because of its larger potential influence on the patient's psyche, capacity to work, and socioeconomic burden. AMI is less prevalent in young people than in older persons, since only 2 to 6 % of the younger population suffers from the condition. Primary PCI is the optimal therapy for STEMI if it can be done promptly, preferably within 90-120 minutes of provider contact. Methods: The present research performed on 60 subjects who had AMI and treated with primary PCI. The cases were allocated into 2 groups, group 1 involved young subjects aged 40 years old or less (30 patients) and group 2 involved older patients aged more than 40 years (30 patients). All patients underwent complete history taking, cardiological clinical examination, investigations, coronary angiography and PCI. Results: Concerning age there was statistically significant difference among two groups while there was no significant difference regarding to sex. regarding risk factors there was significant difference among both groups regarding to hypertension, DM, previous MI, cerebrovascular disease and drug abuse. Regarding to laboratory investigation, there was no significant difference regarding CK, CKMB, creatinine and random blood sugar. There was no significant difference regarding to culprit artery and TIMI flow after PCI while there was statistically significant difference regarding number of vessels involved. Regarding to outcome there was no significant variation among the two groups regarding to acute HF, cardiogenic shock, re-infarction, and death. As regarding to bleeding, it was significant higher in group II. Conclusions: Prevalence of Acute ST Elevation Myocardial Infarction “STEMI” in young people is increasing due to sedentary and stressful lifestyle and bad habits as smoking and addiction. The most widespread and important risk factors in these patients are smoking, addiction, mental stress and hyperlipidemia with less prevalence of hypertension and diabetes mellitus. Young patients present most commonly with anterior then inferior STEMI.

Speckle Tracking as Predictor of Coronary Artery Disease in Diabetic Female with Acute Chest Pain

Background: Cardiovascular disease is the most common reason of mortality and morbidity all-over the world and is the major complication of diabetes. Diabetes mellitus (DM) has reached epidemic proportions worldwide and the consequences of its diagnosis are as severe as a diagnosis of coronary artery disease (CAD). Females are more likely to develop atypical symptoms of coronary CAD than males later in life. Imaging of deformation by two-dimensional speckle-tracking echocardiography (2DSTE) has developed as a highly effective method for quantification of the function of myocardium. This research aimed to evaluate the accuracy of diagnosis using speckle tracking for prediction of the existence or absence of severe CAD in diabetic female with acute chest pain by using two-dimensional echocardiography. Methods: This study is a cohort prospective research which was carried out at the department of cardiology, Tanta University Hospitals and National Heart Institute from the duration of October 2019 to September 2020 on 60 diabetic female patients above 18 years old with acute chest pain may be prolonged for > 20 minutes or transient, changes in ECG in the form of depression of ST segment and/or inversion of T wave (ECG may be normal) and cardiac biomarkers (troponin and CKMB) may be elevated or normal. Results: 2D speckle tracking was good predictor for multi-vessels disease with 95% total accuracy, then for single vessels disease with 85% total accuracy and finally for double vessel disease stenosis with 80% accuracy as shown in table. Among Non-STEMI group, 2D speckle tracking was good predictor for multi-vessels disease with 95% total accuracy, then for single vessels disease with 80% total accuracy and finally for double vessel disease stenosis with 75% accuracy as shown in table. Conclusions: We found that speckle tracking is effective in predicting presence of CAD in diabetic female patients had acute chest pain and in prediction of affected vessels depending on the distribution of affected segments in longitudinal strain by GLS. In addition, it can be used as non-invasive test for patients with acute coronary syndrome.