CORONARY THROMBUS LOAD ON ANGIOGRAPHY IN YOUNG AND ELDERLY PATIENTS WITH ST ELEVATED MYOCARDIAL INFARCTION - AN OBSERVATIONAL STUDY

Abstract

Introduction:Acute myocardial infarction is common causes of death worldwide specially in advancing age.It is uncommon disease in young individual and its incidence varies between 2% and 10%. Lifestyle and dietary changes have lead to obesity, increase level of blood pressure, glucose and cholesterol in younger adults. As a result, these individuals are prone to increased atherothrombotic state. Methodology:A descriptive observational study was conducted from September 2015 to December 2016 after approval from institutional ethics committee and written informed consent from patients at SDMH, Jaipur. 92 patients with ST segment elevated MI were included in the study. Socio demographic, clinical, investigation & treatment information were collected. Data obtained were compiled & analyzed using Microsoft Excel and Primer software. Results:Out of 92 cases, 79 (85.9%) were male and 13 (14.1%) were female. 34 (37%) cases were in young age group (<45 yrs) and 58(63%) cases were in older age group (>45 yrs). Significant difference is observed in mean thrombus load in young age group (3.79±1.23) and older age group (2.86±1.47). Mean thrombus load was significantly more in young age group in male (3.80±1.22) as compared to older (2.91±1.41) andalso in female (3.67±1.52) as compared to older (2.60±1.77). Conclusion: The most common pathophysiology associated with ST elevated myocardial infarction was thrombus. Factors like male, young age, smoking, dyslipidemia, diabetes mellitus, and hypertensionhad high thrombus load.

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ISSN: 2320-5407 Int. J. Adv. Res. 11(04), 1003-1007
1003
Journal Homepage: - www.journalijar.com
Article DOI: 10.21474/IJAR01/16753
DOI URL: http://dx.doi.org/10.21474/IJAR01/16753
RESEARCH ARTICLE
CORONARY THROMBUS LOAD ON ANGIOGRAPHY IN YOUNG AND ELDERLY PATIENTS WITH
ST ELEVATED MYOCARDIAL INFARCTION - AN OBSERVATIONAL STUDY
Vivek Agarwal1, Archana Garg2 and Manoj Kumar Gupta3
1. Assistant Professor, Department of Medicine, Geetanjali Medical College and Hospital, Udaipur, Rajasthan,
India.
2. Associate Professor and Unit Head, Department of Ophthalmology, J L N Medical College and Hospitals,
Ajmer, Rajasthan, India.
3. Assitant Professor, Department of PSM, S M S Medical College and Hospitals, Jaipur, Rajasthan, India.
……………………………………………………………………………………………………....
Manuscript Info Abstract
……………………. ………………………………………………………………
Manuscript History
Received: 28 February 2023
Final Accepted: 31 March 2023
Published: April 2023
Key words:-
Myocardial Infraction, STEMI,
Thrombus Load
Introduction:Acute myocardial infarction is common causes of death
worldwide specially in advancing age.It is uncommon disease in young
individual and its incidence varies between 2% and 10%. Lifestyle and
dietary changes have lead to obesity, increase level of blood pressure,
glucose and cholesterol in younger adults. As a result, these individuals
are prone to increased atherothrombotic state.
Methodology:A descriptive observational study was conducted from
September 2015 to December 2016 after approval from institutional
ethics committee and written informed consent from patients at SDMH,
Jaipur. 92 patients with ST segment elevated MI were included in the
study. Socio demographic, clinical, investigation & treatment
information were collected. Data obtained were compiled & analyzed
using Microsoft Excel and Primer software.
Results:Out of 92 cases, 79 (85.9%) were male and 13 (14.1%) were
female. 34 (37%) cases were in young age group (<45 yrs) and
58(63%) cases were in older age group (>45 yrs). Significant difference
is observed in mean thrombus load in young age group (3.79±1.23) and
older age group (2.86±1.47). Mean thrombus load was significantly
more in young age group in male (3.80±1.22) as compared to older
(2.91±1.41) andalso in female (3.67±1.52) as compared to older
(2.60±1.77).
Conclusion: The most common pathophysiology associated with ST
elevated myocardial infarction was thrombus. Factors like male, young
age, smoking, dyslipidemia, diabetes mellitus, and hypertensionhad
high thrombus load.
Copy Right, IJAR, 2023,. All rights reserved.
……………………………………………………………………………………………………....
Introduction:-
Acute myocardial infarction is one of the most common causes of death worldwide, and it is more common in
person of advancing age.[1] The rate of MI rises sharply in both men and women with increasing age. The proportion
of patient with acute coronary syndrome event who have STEMI varies across observation studies from 29% to
47%.[2,3] It is uncommon disease in young individual and its incidence varies between 2% and 10%.[4,5,6] Lifestyle
Corresponding Author:- Vivek Agarwal
Address:- Assistant Professor, Department of Medicine, Geetanjali Medical College and
Hospital, Udaipur, Rajasthan, India.

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and dietary changes have lead to obesity, increase level of blood pressure, glucose and cholesterol in younger adults.
As a result, these individuals are prone to increased atherothrombotic state. Several studies in India suggests
substantial morbidity and mortality resulting from CHD. In 1990, 1.18 million people died in India as consequences
of CHD; by 2010, this number increased to 2.03 million. CVD probably represent 25% of all deaths in India. Studies
also shows that CHD prevalence is higher in men and in urban residents. Prevalence of CHD in India recently was
estimated at more than 10% in urban areas and 4.5% in rural areas.[7] Despite advances in diagnosis and
management, STEMI remains a major public health problem in the industrialized world and is on the rise in
developing countries.
Objectives:-
The aim of the study is to compare thrombus load in young (< 45 years) and old (> 45 years) patients with ST
segment elevated myocardial infarction.
Materials And Methods:-
A descriptive observational study was conducted from September 2015 to December 2016 at Santokba Durlabhji
Memorial Hospital, Jaipur. Sample size was calculated at 81 patients considering prevalence of Coronary
angiography with STEMI procedure in the institute be 30%. 92 patients with ST segment elevated MI who have
underwent coronary angiogram within seven days of primary event were included in the study. Socio demographic,
clinical, investigation & treatment information were collected on a pre-structured performa. Data obtained were
compiled & analyzed using Microsoft Excel and Primer software. Approval for study was taken from institutional
ethics committee. Written informed consent was taken from each patient.
Results:-
Out of 92 cases, 79 (85.9%) were male and 13 (14.1%) were female. 34 (37%) cases were in young age group (<45
yrs) and 58 (63%) cases were in older age group (>45 yrs). 39.2% and 60.8% cases were male in young and older
age group respectively, while 23.1% and 76.9% were female in respective group. 53 (57.6%) were smokers with
43.4% & 56.6% cases in young & older age group. Obesity was seen in 8 (8.7%) cases, 6 (75%) cases were in older
age group, while 2 (25%) cases were in young age group. Diabetes was present in 41 (44.6%) cases, 32 (78%) cases
were in older age group as compared to 9 (22%) cases in young age group. Hypertension was present in 39 (42.4%)
cases, 28 (71.8%) cases were in age >45 yrs as compared to 11 (28.2%) cases in young age group. 45 (48.9%) cases
had dyslipidemia in the study. Dyslipidemia is seen in 19 (42.2%) cases were in young age group as compared to 26
(57.8%) cases in age group >45 years. Anterior wall MI was present in 57 (62%) cases, inferior wall MI in 34 (37%)
cases and 1 (1%) case was having lateral wall MI. AWMI was seen in 38.6% in young age group as compared to
61.4% in age group 45 years. Only 22 cases received thrombolytic therapy with streptokinase. 54 (58.7%) cases
underwent primary PCI. 32 cases were in age group >45 years and 22 were in young age group. In young age group,
39.7% had single vessel disease, 39.1% had double vessel disease while 18.2% had triple vessel disease. In age >45
years, 60.3% had single vessel disease, 60.9% had double vessel disease, and 81.8% had triple vessel disease.
Significant difference is observed in mean thrombus load in young age group (3.79±1.23) and older age group
(2.86±1.47). Mean thrombus load in males is 3.26±1.40 and 2.84±1.72 in females. Among the male cases mean
thrombus load was significantly more in young age group (3.80±1.22) as compared to older (2.91±1.41). In female
cases also mean thrombus load was high in young (3.67±1.52) as compared to older (2.60±1.77). Mean thrombus
load in smoker was 3.43±1.44 as compared to 2.89±1.41 in non smoker. Mean thrombus load was significantly
differ in young smokers (3.96±1.15) & older smokers (3.03±1.54). Mean thrombus load was 3.50±1.41 in obese
while it is 3.17±1.45 in non obese. No significant difference is observed within obese as well as with non obese.
There is significant difference in mean thrombus load in diabetic group (3.53±1.28) & non – diabetic group
(2.94±1.52) as well as in older diabetic group (3.34±1.28) & older non – diabetic group (2.26±1.48). Mean thrombus
load was 3.48±1.43 in hypertensive while it is 3.00±1.44 among non hypertensive. Significant difference is noted in
older age group, for mean thrombus load in hypertensive (3.34±1.42) and non hypertensive (2.37±1.37). Significant
difference was present in mean thrombus load in dyslipidemia patient (3.57±1.21) & non dyslipidemic patients
(2.85±1.57) as well as in older dyslipidemia group (3.34±1.26) & older non – dyslipidemia group (2.46±1.52). Mean
thrombus load in AWMI was 3.31±1.32 while in IWMI it is 3.02±1.63. Mean thrombus load in thrombolysis group
was 3.04±1.52, in PCI group was 3.44±1.31 & in heparin group was 2.62±1.66.

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Discussion:-
In present study mean age was 54.1±14 yrs as compared to study reported by Hiroyuki Jinnouchi et al.[8] (58.6 ±16
yrs), Su-Kiat Chua et al.[5] (61±13 yrs) and Tarek A.N. Ahmed et al.[9] (58±11 yrs). In this study male (85.9%)
predominance is seen. Similarly male dominance (80.5%) is seen in study conducted by Hiroyuki Jinnouchi et al.[8].
43.4% patients with smoking history were young while 56.6% were older. Su-Kiat Chua et al.[5]& Seung Hun Lee et
al.[10] reported smoking in 75.8 % & 77.3% in young & 47.2% in older group where as in a study by Hiroyuki
Jinnouchi et al.[8] about 40% were smoker. In our study, obesity was seen in 8.7% while Hiroyuki Jinnouchi et al.[8]
reported 41.5% overweight. In our study 44.6% were diabetic out of which 22% were young while 78% were old
patients. Hiroyuki Jinnouchi et al.[8]& Su-Kiat Chua et al.[5] showed diabetes in 17.2% & 24.5% of young and 47.2%
& 31.1% in older group respectively. In our study hypertension is seen in 42.4% out of which 28.2% were young
whereas 71.8% were old patients. Su-Kiat Chua et al.[5]& Hiroyuki Jinnouchi et al.[8] showed hypertension in 34.3%
& 20.8% of young and 50% & 63.2% in older group respectively. In present study dyslipidemia is seen in 48.9%
patients out of which 42.2% were young while 57.8% were old one. Su-Kiat Chua et al.[5]& Hiroyuki Jinnouchi et
al.[8] reported results in contrast to ours 28.3% & 56.6% in young whereas 19.9% & 24.8% in old age group. In our
study anterior wall MI was present in 62%, inferior wall MI was seen in 37% and only 1% has lateral wall MI. Ratio
of young & old patients is 1:2 who are suffering from AWMI & IWMI. Su-Kiat Chua et al.[5] reported AWMI &
IWMI in 57.6% & 33.3% young & in 52.3% & 36.5% old group whereas Hiroyuki Jinnouchi et al.[8] showed AWMI
& IWMI in 41.5% & 30.2% young & in 46.7% & 35.2% old group respectively. In our study single vessel disease
was present in 63%, double vessel disease was seen in 25% and only 12% has triple vessel disease. Ratio of young
& old patients is 2:3 who are suffering from single & double vessel disease whereas it is 4:1 in triple vessel disease.
Su-Kiat Chua et al.[5] reported similar results while Hiroyuki Jinnouchi et al.[8] reported reversed results in
comparison to our results.
Table 1:- Age-wise distribution of patients.
Factors
Age
Total
(n=92)
p value (Chi-square
test)
<45 yrs
(n=34)
>45 yrs
(n=58)
Male
Female
31 (39.2%)
03 (23.1%)
48 (60.8%)
10 (76.9%)
79 (85.9%)
13 (14.1%)
0.42
Smoker
Non-smoker
23 (43.4%)
11 (28.2%)
30 (56.6%)
28 (71.8%)
53 (57.6%)
39 (42.4%)
0.20
Obese
Non-obese
02 (25%)
32 (38.1%)
06 (75%)
52 (61.9%)
08 (8.7%)
84 (91.3%)
0.73
Diabetes
Non-diabetes
09 (22%)
25 (49%)
32 (78%)
26 (51%)
41 (44.6%)
51 (55.4%)
0.01
Hypertensive
Non-hypertensive
11 (28.2%)
23 (43.4%)
28 (71.8%)
30 (56.6%)
39 (42.4%)
53 (57.6%)
0.20
Dyslipidemia
Non- Dyslipidemia
19 (42.2%)
15 (31.9%)
26 (57.8%)
32 (68.1%)
45 (48.9%)
47 (51.1%)
0.42
AWMI
IWMI
LWMI
22 (38.6%)
11 (32.4%)
01 (100%)
35 (61.4%)
23 (67.6%)
00 (0%)
57 (62%)
34 (37%)
01 (1%)
0.35
STK+ve
STK-ve
06 (27.3%)
28 (40%)
16 (72.7%)
42 (60%)
22 (23.9%)
70 (76.1%)
0.41
Primary PCI+ve
Primary PCI-ve
22 (40.7%)
12 (31.6%)
32 (59.3%)
26 (68.4%)
54 (58.7%)
38 (41.3%)
0.50
Single vessel
Double vessel
Triple vessel
23 (39.7%)
09 (39.1%)
02 (18.2%)
35 (60.3%)
14 (60.9%)
09 (81.8%)
58 (63%)
23 (25%)
11 (12%)
0.39
Table 2:- Comparison of thrombus load.
Factors
N
Thrombus load
p value (t test)

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<45yrs
>45 yrs
34
58
3.79±1.23
2.86±1.47
0.00
Male
Female
79
13
3.26±1.40
2.84±1.72
0.34
Smoker
Non-smoker
53
39
3.43±1.44
2.89±1.41
0.08
Obese
Non-obese
08
84
3.50±1.41
3.17±1.45
0.54
Diabetes
Non-diabetes
41
51
3.53±1.28
2.94±1.52
0.05
Hypertensive
Non-hypertensive
39
53
3.48±1.43
3.00±1.44
0.12
Dyslipidemia
Non- Dyslipidemia
45
47
3.57±1.21
2.85±1.57
0.02
AWMI
IWMI
LWMI
57
34
01
3.31±1.32
3.02±1.63
3.00
-----
Thrombolysis
PCI
Heparin
22
54
16
3.04±1.52
3.44±1.31
2.62±1.66
0.11*
* one way ANOVA test
Table 3:- Age-wise comparison of thrombus load.
Factors
Age
N
<45yrs
p value (t
test)
N
>45 yrs
p value (t
test)
Male
Female
31
03
3.80±1.22
3.67±1.52
0.86
48
10
2.91±1.41
2.60±1.77
0.55
Smoker
Non-smoker
23
11
3.96±1.15
3.45±1.37
0.26
30
28
3.03±1.54
2.67±1.38
0.35
Obese
Non-obese
02
32
3.00±1.41
3.84±1.22
0.35
06
52
3.66±1.50
2.76±1.45
0.16
Diabetes
Non-diabetes
09
25
4.22±1.09
3.64±1.25
0.23
32
26
3.34±1.28
2.26±1.48
0.00
Hypertensive
Non-hypertensive
10
24
3.90±1.44
3.75±1.15
0.75
29
29
3.34±1.42
2.37±1.37
0.01
Dyslipidemia
Non- Dyslipidemia
19
15
3.89±1.10
3.66±1.39
0.59
26
32
3.34±1.26
2.46±1.52
0.02
AWMI
IWMI
LWMI
21
12
01
3.71±1.18
3.92±1.32
3.00
-----
36
22
3.08±1.36
2.50±1.59
0.15
Thrombolysis
PCI
Heparin
06
22
06
3.16±1.32
4.13±1.03
3.16±1.47
0.08*
16
32
10
3.00±1.63
2.97±1.28
2.30±1.77
0.42*
* one way ANOVA test
Table 4:- Age-wise comparison of thrombus load among risk factors.
Factors
Age
p value (t test)
N
<45yrs
N
>45 yrs
Male
31
3.80±1.22
48
2.91±1.41
0.01
Smoker
23
3.96±1.15
30
3.03±1.54
0.02
Obese
02
3.00±1.41
06
3.66±1.50
0.61
Diabetes
09
4.22±1.09
32
3.34±1.28
0.07

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Hypertensive
10
3.90±1.44
29
3.34±1.42
0.29
Dyslipidemia
19
3.89±1.10
26
3.34±1.26
0.14
Conclusion:-
The most common pathophysiology associated with ST elevated myocardial infarction was thrombus. Males had
high thrombus load and young study population had more thrombus load. High thrombus load was more after
associated with smoking, dyslipidemia, diabetes mellitus, and hypertension. AWMI was more commonly seen in
study population and also there was significant thrombus load even after thrombolysis. Young age group was more
commonly associated with single vessel disease as compared to > 45 years age group.
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