Myocardial ischemia due to coronary artery disease is an extremely rare condition in childhood and adolescence. Absence of obvious serious risk factors remains a challenge to modern cardiology. We present the case of a 14-year-old boy who underwent quadruple-vessel coronary artery bypass grafting with bilateral pedicled internal mammary artery and bilateral radial artery grafting. We try to highlight a rare but important 4G variant PAI-1 (SERPINE 1) gene mutation as the etiology of severe coronary artery disease in our patient. To the best of our knowledge, he is one of the youngest patients who underwent coronary artery bypass surgery with 4 arterial grafts.
YeZLiuEHCHigginsLPT. Seven haemostatic gene polymorphysms in coronary disease: meta-analysis of 66,155 cases and 91,307 controls. Lancet. 2006;367:651-658.
2.
BoekholdtSMBijsterveldNRMoonsAHMLeviMBullerHRPetersRJG. Genetic variation in coagulation and fibrinolytic proteins and their relation with acute myocardial infarction: a systematic review. Circulation. 2001;104:3063-3068.
3.
Atherosclerosis, Thrombosis, and Vascular Biology Italian Study Group. No evidence of association between prothrombotic gene polymorphisms and the development of acute myocardial infarction at a young age. Circulation. 2003;107:1117-1122.
4.
NikolopoulosGKBagosPGTsangarisI. The association between plasminogen activator inhibitor type 1 (PAI-1) levels, PAI-1 4G/5G polymorphism, and myocardial infarction: a Mendelian randomization meta-analysis. Clin Chem Lab Med. 2014;52:937-950.
5.
TsantesAENikolopoulosGKBagosPG. Association between the plasminogen activator inhibitor-1 4G/5G polymorphism and venous thrombosis: a meta-analysis. Thromb Haemost. 2007;97:907-913.
6.
ErikssonPKallinBVan’t HooftFMBavenholmPHamstenA.Allele-specific increase in basal transcription of the plasminogen-activator inhibitor 1 gene is associated with myocardial infarction. Proc Natl Acad Sci U S A. 1995;92:1851-1855.
7.
DawsonSHamstenAWimanBHenneyAHumphriesS.Genetic variation at the plasminogen activator inhibitor-1 locus is associated with altered levels of plasma plasminogen activator inhibitor-1 activity. Arterioscl Thromb. 1991;11:183-190.
8.
OnalanOBaltaGOtoA. Plasminogen activator inhibitor-1 4G4G genotype is associated with myocardial infarction but not with stable coronary artery disease. J Thromb Thrombolysis. 2008;26:211-217.
9.
MostafaBMokhtarDBadrAEl Din NasserG.Plasminogen activator inhibitor-1 4G/5G gene polymorphism in hemodialysis patients with cardiovascular disease. Egypt J Haematol. 2013;38:29-35.
10.
BerberogluMEvliyaogluOAdiyamanP. Plasminogen activator inhibitor-1 (PAI-1) gene polymorphism (-675 4G/5G) associated with obesity and vascular risk in children. J Pediatr Endocrinol Metab. 2006;19:741-748.
11.
delaCruz-MossoUMunoz-ValleJFSalgado-BarnabeAB. Body adiposity but not insulin resistance is associated with -675 4G/5G polymorphism in the PAI-1 gene in a sample of Mexican children. J Pediatr (Rio J). 2013;89:492-498.
12.
IacovielloLBurzottaFDi CastelnuovoAZitoFMarchioliRDonatiMB.The 4G/5G polymorphism of PAI-1 promoter gene and the risk of myocardial infarction: a meta-analysis. Thromb Haemost. 1998;80:1029-1030.
13.
GardemannALohreJKatzNTillmannsHHehrleinFWHaberboschW.The 4G4G genotype of the plasminogen activator inhibitor 4G/5G gene polymorphism is associated with coronary atherosclerosis in patients at high risk for this disease. Thromb Haemost. 1999;82:11211-11216.
14.
HampstenAde FaireUWalldiusG. Plasminogen activator inhibitor in plasma: risk factor for recurrent myocardial infarction. Lancet. 1987;2:3-9.
BrogrenHKarlssonLAnderssonMWangLErlingeDJernS.Platelets synthesize large amounts of active plasminogen activator inhibitor 1. Blood. 2004;104:3943-3948.
17.
WuQZhaoZ.Inhibition of PAI-1: a new anti-thrombotic approach. Curr Drug Targets Cardiovasc Haematol Disord. 2002;2:27-42.
