Characteristic of the coronary vascular system, structural and functional state of the heart and endothelium-dependent vasodilation in young patients with acute coronary syndrome and ST elevation

Main Article Content

O. M. Parkhomenko
Ya. M. Lutay
O. I. Irkin
D. O. Bilyi
A. O. Stepura
S. P. Kushnir
Yu. M. Sokolov
M. Yu. Sokolov


The aim – to reveal features of the coronary vascular system, structural and functional state of the heart and endothelium-dependent vasodilatation in ST-elevation acute coronary syndrome (STEMI) patients of different age groups.
Materials and methods. We analyzed the data of instrumental examination of patients who were admitted to the emergency departments from 2000 to 2015, with STEMI. Patients were distributed into two groups depending on age: 1 group – patients < 45 years, 2 group  45 years. Coronary angiography (CAG) was performed within the first hours after the admission. Endothelium-dependent, flow-mediated vasodilation (FMD) test and echocardiography were performed within 24 hours of admission and again on the 7th day.
Results and discussion. According to сoronary angiography, elder patients were more likely to have infarction-dependent coronary artery disease (33.3 vs. 20.3 %; p=0.037), and multi-vessel coronary artery disease (12.0 vs. 4.8 %; p=0.048). Patients in the 1st group demonstrated a lower frequency of hemodynamically significant lesions of coronary vessels (p<0.001) and less marked disorders of the lipid spectrum. Patients of the group 1 had less thickness of the interventricular septum. 10.7±1.5 mm versus 11.6±1.6 mm, p=0.024). Young patients had initially better diastolic function (Е/А) (1.29±0.40 versus 1.00±0.52, p=0.008). At day 7 in patients of the 1st group there was a more marked increase in the left ventricular
ejection fraction and end-diastolic diastolic index of the left ventricle (7.6 versus 3.4 %; p<0.05) than in the patients of the 2nd group. Young patients demonstrated a tendency to increase of end-diastolic index > 10 %, in dynamics, at 39.7 versus 27.8 % elder patients (p=0.053), lower growth of the diameter of the brachial artery (4.7±4.1 vs. 6.7±5.1 %; p<0.05), but more rapid improvement of endothelial function in the dynamics of observation (104 vs. 23 %; p<0.05).
Conclusions. The percentage of damage of coronary artery disease in STEMI young patients did not differ from elder patients but insignificant coronary artery stenosis is detected more often (р<0.001) and acute myocardial infarction in the right coronary artery is less common (р<0.037). Young patients with multi-vessel coronary disease have significant violations of the lipid blood spectrum (increased levels of total cholesterol, low density lipoprotein cholesterol). Indicators of intracardiac hemodynamic did not differ between age groups initially, however, the course of acute myocardial infarction in young patient was characterized by the tendency to develop early post-infarction dilatation (p=0.053). According to the FMD test young patients at the onset had a worse indicator of than elder patients (p<0.043), however the diameter of the brachial artery in the dynamics of observation, significantly increased (p<0.05).

Article Details


acute coronary syndrome, acute myocardial infarction, young age, coronary angiography, echocardio - graphy, endothelial dysfunction, dyslipidemia


Parkhomenko OM, Amosova KM, Dziak HV, Knyshov HV, Kovalenko VM, Netiazhenko VZ, Koval OA, Kopytsia MP, Sokolov YuM, Todurov BM, Tashchuk VK, Shumakov VO, Irkin OI, Sokolov MIu, Holoborodko BI, Kozhukhov SM, Lutai YaM, Shumakov OV. Guidelines of the Association of cardiologist of Ukraine for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Ukrainskyi Kardiolohichnyi Zhurnal [Ukrainian Cardiology Journal ] 2013; supplement 3 (in Ukr.).

Shiller N, Osipov M.A. “Klinicheskaya ekhokardiografiya” - 2-e izd. M. : Praktika,2005.p.62–73. (in Russ).

Appleton CP, Jensen JL, Hatle LK, Oh JK. Doppler evaluation of left and right ventricular diastolic function: a technical guide for obtaining optimal flow velocity recordings. J. Am. Soc. Echocardiogr. 1997;10:271–91.

Bajaj S, Shamoon F, Gupta N, Parikh R, Parikh N, Debari VA, Hamdan A, Bikkina M. Acute ST-segment elevation myocardial infarction in young adults: who is at risk? Coron Artery Dis. 2011;22(4):238–244.

Brunner H, Cockcroft JR, Deanfield J, Donald A, Ferrannini E, Halcox J, Kiowski W, Lüscher TF, Mancia G, Natali A, Oliver JJ, Pessina AC, Rizzoni D, Rossi GP, Salvetti A, Spieker LE, Taddei S, Webb DJ; Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension. Endothelial function and dysfunction. Part II: Association with cardiovascular risk factors and diseases. A statement by the Working Group on Endothelins and Endothelial Factors of the European Society of Hypertension. J Hypertens 2005; 23:233–246.

Celermajer DS, Sorensen KE, Gooch VM, Spiegelhalter DJ, Miller OI, Sullivan ID, Lloyd JK, Deanfield JE. Non - invasive detection of endothelial dysfunction in children and adults at risk of atherosclerosis. Lancet. 1992;340:1111–1115.

Chen SM, Tsai TH, Hang CL, Yip HK, Fang CY, Wu CJ, Guo GB. Endothelial dysfunction in young patients with acute ST-elevation myocardial infarction. Heart Vessels 2011;26(1):2–9.

Choudhury L, Marsh JD. Myocardial infarction in young patients. Am J Med 1999; 107:254–61.

Egred M, Viswanathan G, Davis GK. Myocardial infarction in young adults. Postgrad. Med J 2005;81:741–745.

Fournier JA., Sanchez A, Quero J, Fernandez-Cortacero JA, Gonzalez-Barrero A. Myocardial infarction in men aged 40 years or less: a prospective clinical-angiographic study. Clin.Cardiol.1996;19:631–636.

Garoufalis S, Kouvaras G, Vitsias G, Perdikouris K, Markatou P, Hatzisavas J, et al. Comparison of angiographic findings, risk factors, and long term follow-up between young and old patients with a history of myocardial infarction. Int J Cardiol. 1998;67(1):75–80.)

Hoit BD, Gilpin EA, Henning H, Maisel AA, Dittrich H, Carlisle J, Ross J Jr. Myocardial infarction in young patients: an analysis by age subsets. Circulation 1986;74:712–721.

Hosseini SK, Soleimani A, Karimi AA, Sadeghian S, Darabian S, Abbasi SH, Ahmadi SH, Zoroufian A, Mahmoodian M, Abbasi A. Clinical features, management and in-hospital outcome of ST elevation myocardial infarction (STEMI) in young adults under 40 years of age. Monaldi Arch. Chest. Dis. 2009;72:71–76.

Lang RM, Bierig M, Devereux RB, Flachskampf FA, Foster E, Pellikka PA, Picard MH, Roman MJ, Seward J, Shanewise J, Solomon S, Spencer KT, St John Sutton M, Stewart W; American Society of Echocardiography's Nomenclature and Standards Committee; Task Force on Chamber Quantification; American College of Cardiology Echocardiography Committee; American Heart Association; European Association of Echocardiography, European Society of Cardiology. Recommendations for chamber quantification . Eur J Echocardiography 2006; 7:79–108.

Luscher TF, Noll G. The pathogenesis of cardiovascular disease: role of the endothelium as a target and mediator. Atherosclerosis 1995;118 Suppl:81–90.

Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med 2011;3:e442.

Nichols M, Townsend N, Scarborough P, Rayner M. Cardiovascular disease in Europe: epidemiological update. Eur Heart J2013;34:3028–3034.)

Office of National Statistics. Weekly incidence of heart attacks.

Sinha R1, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G, Sherwin RS, Caprio S. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med 2002;346:802–10.

Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC), Steg PG, James SK, Atar D, Badano LP, Blömstrom-Lundqvist C, Borger MA, Di Mario C, Dickstein K, Ducrocq G, Fernandez-Aviles F, Gershlick AH, Giannuzzi P, Halvorsen S, Huber K, Juni P, Kastrati A, Knuuti J, Lenzen MJ, Mahaffey KW, Valgimigli M, van 't Hof A, Widimsky P, Zahger D. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation. Eur. Heart J. 2012; 33:2569–2619.

Tanriverdi H1, Evrengul H, Tanriverdi S, Turgut S, Akdag B, Kaftan HA, Semiz E. Improved endothelium dependent vasodilation in endurance athletes and its relation with ACE I/D polymorphism. Circ J. 2005;69:1105–1110

Thijssen DH1, Black MA, Pyke KE, Padilla J, Atkinson G, Harris RA, Parker B, Widlansky ME, Tschakovsky ME, Green DJ. Assessment of flow - mediated dilation in humans: a methodological and physiological guideline. American journal of physiology 2011;300:2–12.

Veludo ET, Marques VC, Simoes MV, Furuta MS, Figueiredo GL, Viviani LF, et al. Clinical profile, coronary angiography findings and early outcome in young patients with acute myocardial infarction in the thrombolytic era. Arq Bras Cardiol. 1997;68(6):401–5.

Zimmerman FH, Cameron A, Fisher LD, Ng G. Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis (Coronary Artery Surgery Study Registry). J Am Coll Cardiol. 1995;26:654–661.

Most read articles by the same author(s)

1 2 3 4 > >>