Infarto agudo do miocárdio em pacientes com idade inferior a 40 anos / Acute myocardial infarction in patients under 40 years old

RESUMO

Objetivo: Avaliar retrospectivamente a evolução imediata e tardia de pacientes com idade igual ou inferior a 40 anos. Casuística e Métodos: De 1096 pacientes com 1º infarto agudo do miocárdio, internados consecutivamente entre 1973 e 1986, 73 (7%) apresentavam idade igual ou inferior a 40 anos. Foram excluídos casos secundários a outras cardiopatias, bem como os devidos a complicações de procedimentos de revascularização. Resultados: 66 (90%) eram do sexo masculino, com idade média de 35 (15 a 40) anos. Os fatores de risco foram tabagismo 64 (88%), hipertensão arterial sistémica 16 (22%), dislipidemia 12 (16%) e diabetes mellitus 3 (4%). Em 7 (9%) não foram observados fatores de risco. O infarto localizava-se na parede anterior em 50 (68%) e na inferior em 23 (32%). Quanto à presença da insuficiência cardíaca, pela classificação de Killip, 70 (96%) estavam nos grupos I-II e 3 (4%) nos III-IV. Dos 63 (86%) que realizaram cinecoronariografia, considerando-se como significativas lesões >70%, 38 (60%) apresentavam doença uniarterial, 12 (19%) biarterial, 6 (9%)...

ABSTRACT

Purpose: To evaluate the short and long-term prognosis of a group of patients aged 40 and under, who developed an acute myocardial infarction. Patients and Methods: In the last 15 years we studied a group of 73 patients aged 40 and under with a confirmed diagnosis of first acute myocardial infarction. Patients with infarctions caused by coronary embolisms or to revscularization procedures were excluded. Results: Ninety percent were male and mean the age was 35. The most frequent risk factors observed were cigarette smoking in 64 (88%), bypertension in 16 (22%), bypercholesterolemia in 12 (16%) and diabettes in 3 (4%). Seven (9%) patients had no risk factors. The myocardial infarction was anterior em 50 (68%) cases and inferior in the remaining 23 (32%). Severe heart failure (Killip 111 and IV) was present in 3 (4%). Angiographic studies were performed in 63 (86%). Cineangiography showed critical coronary lesions (obstruction > 70% in one vessel in 38 (60%) patients, multivessel disease in 18 (28%) and 7 (12%) had normal coronary vessels. In-hospital mortality was 5% (3 patients died due to severe heart failure and 1 due to cerebro-vascular accident). The 56 survivors were followed-up to 15 years, with overall survival of 74%. Fourty-nine (71%) were assymptomatic and 7 (10%) had reccurrent chest pai. There were 7 (10%) had late deaths and follow-up was lost in 6 (9%)...