Presenter Status
Fellow
Abstract Type
Research
Primary Mentor
Lindsey Malloy Walton
Start Date
12-5-2025 11:30 AM
End Date
12-5-2025 1:30 PM
Presentation Type
Abstract
Description
Background: Acute myocardial infarction (MI) is rare in pediatric patients, with limited published data on incidence, diagnosis, management strategies, and outcomes. We conducted a systematic retrospective review of patients aged 1 day to 21 years who presented with concerns for ST-elevation myocardial infarction at our institution and an affiliated adult hospital (1/2013-12/2023)
Methods: Data collected from electronic medical records included patient demographics, clinical presentation, diagnostic findings, interventions, treatments, and outcomes. Demographic variables collected were patient age at presentation, sex, and race. Medical histories included history of congenital heart disease, symptoms at presentation (chest pain, dyspnea, shortness of breath, shoulder pain, palpitations, nausea, syncope, cardiac arrest). Results from diagnostic testing included ECG changes, echocardiographic findings, cardiac enzymatic marker levels, advanced cardiac imaging results, and results of cardiac stress testing. The collected data included interventions with pharmacological treatments, surgical procedures, and interventional cardiology procedures. Short- and long-term outcomes were evaluated including transfer of patient between facilities, survival rates, and complications of procedures. Data was collected and managed using REDCap electronic data capture tools.
Analysis: Descriptive statistics were used to summarize patient demographics, clinical presentation, diagnostic findings, interventions, and outcomes. Continuous variables were expressed as means ± standard deviations or medians and ranges as appropriate, and categorical variables as frequencies and percentages.
Results: Out of 965 screened patients, 13 met the inclusion criteria. The cohort had a mean age of 15 years (SD ± 4 years), with the youngest patient being 11 months old. The study population consisted of 12 males (92%) and 1 female (8%), with ethnic distribution as follows: Caucasian (67%), African American (17%), and Hispanic (17%). Electrocardiogram (ECG) changes indicative of ST changes were observed in all patients, with ST-elevation distributions in inferior, lateral, anteroseptal, and noncoronary regions. Echocardiography revealed a normal ejection fraction (EF) in 64% of patients. Troponin I levels, obtained in 12 patients, ranged from 0.05 to 22.9 ng/mL. Aspirin and heparin were the only medications used for acute management. Most patients (54%) presenting with concern for STEMI had congenital heart disease. Three patients (23%) with congenital heart disease were undiagnosed at the time of initial presentation. Nine patients (69%) were transferred to an adult hospital, with seven (54%) undergoing cardiac catheterization. One patient, who did not undergo a cardiac catheterization, required surgical coronary artery bypass. No catheter interventions were performed at the adult facility. Three patients (23%) had cardiac arrest during cardiac catheterization resulting in ECMO cannulation. All patients with cardiac arrest had congenital heart disease. There was one death.
Conclusion: This study underscores the rarity of acute MI in pediatric patients despite the common presentation of ST segment changes on ECG. The findings reveal significant variability in medical management and emphasize the importance of initial diagnostic evaluations at pediatric centers, particularly to rule out CHD. The lack of catheterization interventions at the adult facility suggests that pediatric cases may be effectively managed within pediatric settings. The study calls for the development of standardized guidelines to ensure consistent and effective management of acute MI in pediatric patients, ultimately aiming to improve clinical outcomes for this unique population.
Acute Myocardial Infarction in Pediatrics: Not the Same as Acute Myocardial Infarction in Adults
Background: Acute myocardial infarction (MI) is rare in pediatric patients, with limited published data on incidence, diagnosis, management strategies, and outcomes. We conducted a systematic retrospective review of patients aged 1 day to 21 years who presented with concerns for ST-elevation myocardial infarction at our institution and an affiliated adult hospital (1/2013-12/2023)
Methods: Data collected from electronic medical records included patient demographics, clinical presentation, diagnostic findings, interventions, treatments, and outcomes. Demographic variables collected were patient age at presentation, sex, and race. Medical histories included history of congenital heart disease, symptoms at presentation (chest pain, dyspnea, shortness of breath, shoulder pain, palpitations, nausea, syncope, cardiac arrest). Results from diagnostic testing included ECG changes, echocardiographic findings, cardiac enzymatic marker levels, advanced cardiac imaging results, and results of cardiac stress testing. The collected data included interventions with pharmacological treatments, surgical procedures, and interventional cardiology procedures. Short- and long-term outcomes were evaluated including transfer of patient between facilities, survival rates, and complications of procedures. Data was collected and managed using REDCap electronic data capture tools.
Analysis: Descriptive statistics were used to summarize patient demographics, clinical presentation, diagnostic findings, interventions, and outcomes. Continuous variables were expressed as means ± standard deviations or medians and ranges as appropriate, and categorical variables as frequencies and percentages.
Results: Out of 965 screened patients, 13 met the inclusion criteria. The cohort had a mean age of 15 years (SD ± 4 years), with the youngest patient being 11 months old. The study population consisted of 12 males (92%) and 1 female (8%), with ethnic distribution as follows: Caucasian (67%), African American (17%), and Hispanic (17%). Electrocardiogram (ECG) changes indicative of ST changes were observed in all patients, with ST-elevation distributions in inferior, lateral, anteroseptal, and noncoronary regions. Echocardiography revealed a normal ejection fraction (EF) in 64% of patients. Troponin I levels, obtained in 12 patients, ranged from 0.05 to 22.9 ng/mL. Aspirin and heparin were the only medications used for acute management. Most patients (54%) presenting with concern for STEMI had congenital heart disease. Three patients (23%) with congenital heart disease were undiagnosed at the time of initial presentation. Nine patients (69%) were transferred to an adult hospital, with seven (54%) undergoing cardiac catheterization. One patient, who did not undergo a cardiac catheterization, required surgical coronary artery bypass. No catheter interventions were performed at the adult facility. Three patients (23%) had cardiac arrest during cardiac catheterization resulting in ECMO cannulation. All patients with cardiac arrest had congenital heart disease. There was one death.
Conclusion: This study underscores the rarity of acute MI in pediatric patients despite the common presentation of ST segment changes on ECG. The findings reveal significant variability in medical management and emphasize the importance of initial diagnostic evaluations at pediatric centers, particularly to rule out CHD. The lack of catheterization interventions at the adult facility suggests that pediatric cases may be effectively managed within pediatric settings. The study calls for the development of standardized guidelines to ensure consistent and effective management of acute MI in pediatric patients, ultimately aiming to improve clinical outcomes for this unique population.
