Document Detail

Young Adult Myocardial Infarction and Ischemic Stroke: the role of paradoxical embolism and thrombophilia (The YAMIS Study).
MedLine Citation:
PMID:  16904535     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: We aimed to investigate the frequency of venous-to-arterial circulation shunts (v-aCS), usually caused by patent foramen ovale (PFO), and thrombophilia in young adults suffering myocardial infarction (MI) and ischemic stroke (IS) and matched healthy control subjects. BACKGROUND: The cause of MI and IS in young adults is often uncertain, and paradoxical embolism might be more frequent than previously thought. METHODS: Young adults (ages 16 to 39 years) surviving MI (n = 101) and IS (n = 101) between 1993 and 1998 were matched by age and gender to 202 control subjects from the same general practitioner practices. The v-aCS were detected by transcranial Doppler after intravenous microbubble ultrasound contrast; "significant" v-aCS (> or =15 microbubble emboli) correlated with PFO on transesophageal echocardiography. A "major" v-aCS was >50 microbubbles spontaneously or >10 microbubbles spontaneously with >80 after provocation. Venous blood was taken for a thrombophilia screen. RESULTS: Myocardial infarction, more frequent in men, was associated with the usual cardiovascular risk factors. More women suffered IS, which was associated only with migraine and hypertension. Neither "significant" nor "major" v-aCS were associated with MI. "Major" v-aCS was found in 24 (25%) IS cases compared with 12 (12%) control subjects (odds ratio 2.80, 95% confidence interval 1.21 to 6.84; p = 0.016). Thrombophilia was not significantly associated with either MI or IS. CONCLUSIONS: Only "major" v-aCS were associated with stroke in young adults. Closure of smaller v-aCS might not be justified.
Sanjay Sastry; Graham Riding; Julie Morris; David Taberner; Nicola Cherry; Anthony Heagerty; Charles McCollum
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2006-07-25
Journal Detail:
Title:  Journal of the American College of Cardiology     Volume:  48     ISSN:  1558-3597     ISO Abbreviation:  J. Am. Coll. Cardiol.     Publication Date:  2006 Aug 
Date Detail:
Created Date:  2006-08-14     Completed Date:  2006-09-21     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  8301365     Medline TA:  J Am Coll Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  686-91     Citation Subset:  AIM; IM    
Academic Surgery Unit, South Manchester University Hospital, Manchester, United Kingdom.
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MeSH Terms
Age of Onset
Arteriovenous Malformations / complications
Brain Ischemia / etiology*
Case-Control Studies
Embolism, Paradoxical / complications*
Heart Septal Defects, Atrial / complications*
Myocardial Infarction / etiology*
Risk Factors
Stroke / etiology*
Thrombophilia / complications*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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