Clinical features of myocardial infarction in young patients. Part 2. Predictors of sudden cardiac death and recurrent cardiovascular events

Objective. To study the features of the clinical course, to determine the frequency of predictors of sudden cardiac death and recurrent cardiovascular events in young patients with myocardial infarction with nonobstructive coronary arteries in comparison with patients with obstructive coronary arteries. Materials and methods. One hundred five young patients with myocardial infarction (MI) were studied. Patients were divided into two groups: the first group included patients with MI with obstructive coronary artery (MIOCA), and the second group included patients MI with non-obstructive coronary arteries (MINOCA). Patients received complete clinical examination, electrocardiography, echocardiography, coronary angiography, myocardial necrosis markers testing. On the 1st and 7th day of hospitalization to determine the risk of sudden cardiac death, patients of both groups underwent high-resolution ECG, assessment of heart rate variability and turbulence. Twelve months after MI, the frequency of recurrent cardiovascular events in the study groups was established. Results. On admission in most young patients a significant number predictors of sudden cardiac death (SCD) were identified. After percutaneous coronary intervention, their number decreased significantly in both study groups. In the MINOCA group, most patients did not undergo stenting of the coronary arteries, they were more likely to show signs of heart electric instability (HEI) and SCD predictors. During the follow-up, the number of recurrent cardiovascular events did not differ in the study groups. Conclusion. Young patients with myocardial infarction non-obstructive coronary arteries who have not undergone percutaneous coronary intervention should be considered to have an increased risk of heart electric instability and sudden cardiac death.