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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.

Authors

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

Institution

Division of Cardiology, Morehouse School of Medicine, Atlanta, GA 30310-1495, USA.

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