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Risk factors for acute non-ST-segment elevation myocardial infarction in a population sample of predominantly African American patients with chest pain and normal coronary arteries.

Abstract

BACKGROUND
We sought to investigate the relationship between echocardiographic left ventricular hypertrophy (LVH) and acute non-ST-elevation segment myocardial infarction (NSTE-MI) in patients with chest pain and angiographically normal coronary arteries.
METHODS
Retrospective analysis of patients admitted for acute chest pain in a large urban hospital serving predominantly African American patients.
RESULTS
131 (of 700) patients had normal coronary arteries or only minimal luminal irregularities (ie, <10% luminal narrowing) on cardiac angiography and available cardiac biomarker data to define the presence or absence of MI. Mean age was 53 +/- 10 years, 76% were African Americans, 88% had a history of hypertension (49% uncontrolled) and 74% had LVH by echocardiography. Of these 131 patients, 22 (17%) had an acute NSTE-MI by creatine kinase MB criteria. The mean systolic blood pressure (BP) was significantly higher in patients with NSTE-MI compared with non-NSTE-MI group (156 +/- 30 vs 143 +/- 25 mm Hg, P=.04). Patients with NSTE-MI were more likely to have LVH (95% vs 70%, P=.03). NSTE-MI was present in 22% of patients with LVH compared with 3% without LVH (P=.02). The in-hospital course of NSTE-MI patients with LVH was not benign: 19% had persistent angina and positive stress thallium suggestive of recurrent myocardial ischemia and 48% had congestive heart failure. The results of multivariable model after adjusting for selected variables revealed that these two preexisting conditions were independently associated with NSTE-MI: LVH (OR=4.0, CI 1.06-10.05) and elevated systolic BP (OR=3.7, CI 1.01-10.64).
CONCLUSION
These findings provide preliminary evidence that LVH and uncontrolled hypertension predispose to NSTE-MI in this patient group.

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  • Authors

    Lapu-Bula R, Onwuanyi A, Bielo MV, Deffer O, Quarshie A, Alema-Mensah E, Cross JA, Oduwole A, Ofili E

    Source

    Ethnicity & disease 21:4 2011 pg 421-8

    MeSH

    Adult
    African Americans
    Aged
    Aged, 80 and over
    Blood Pressure
    Chest Pain
    Coronary Angiography
    Coronary Vessels
    Echocardiography
    Electrocardiography
    Female
    Humans
    Hypertension
    Hypertrophy, Left Ventricular
    Male
    Middle Aged
    Multivariate Analysis
    Myocardial Infarction
    Retrospective Studies
    Risk Factors

    Pub Type(s)

    Journal Article
    Research Support, N.I.H., Extramural
    Research Support, U.S. Gov't, Non-P.H.S.

    Language

    eng

    PubMed ID

    22428345