Highlights
- •Largest study of ACS in patients younger than 30 years.
- •Rising trend in prevalence of ACS in very young patients in a 12-year study period.
- •Overweight, obesity, urbanization and drug abuse are potential risk factors.
- •Thrombotic milieu in the very young versus fibrotic calcific atherosclerotic milieu in the older subset.
- •Higher recanalisation rates in the very young with intensive pharmacological management.
Abstract
Background and aims
Acute coronary syndrome (ACS) in the very young is a rare entity, with limited data.
We aimed to study patterns and profile of ACS in patients aged 20–30 years in comparison
with those above 30 years.
Methods
In this retrospective record-based study, the demographic and clinical profile of
all patients with ACS in the last 12 years (n = 35259) was analysed: group I (20–30
years) and group II (above 30 years). Patients in group II were selected by systematic
sampling. Age, gender, domicile, body mass index (BMI), serum cholesterol, smoking,
alcohol use, drug abuse, diabetes, hypertension, family history, type of ACS, angiographic
findings and management strategies were recorded. Chi-square test and Fischer's exact
test were used for data analysis.
Results
Of 35,259 patients, 0.32% (n = 114) were from the younger age group, with a rising
trend of prevalence over 12 years. Obesity, overweight, urban living, smoking, alcohol
and drug abuse were significantly higher in group I (p < 0.05). Diabetes mellitus and hypertension were more prevalent in group II (p = 0.001). STEMI in group I (76.3%) and NSTEMI in group II (47.1%) were the common modes
of presentation (p = 0.001). 42.1% of group I patients had recanalized coronaries with conservative management
in comparison to 3% in group II (p = 0.001).
Conclusions
There is a rising trend in prevalence of ACS in very young patients. Overweight, obesity,
urbanization and drug abuse are potential risk factors. The younger subset of ACS
patients is different from the older population due to their thrombotic milieu, which
could be more amenable to intensive pharmacologic management.
Graphical abstract
Graphical Abstract
Keywords
Abbreviations:
ACS (acute coronary syndrome), CAD (coronary artery disease), STEMI (ST-elevation myocardial infarction), NSTEMI (non ST-elevation myocardial infarction), UA (unstable angina), BMI (body mass index), WHO (World Health Organization), LVEF (left ventricular ejection fraction), SVD (single vessel disease), DVD (double vessel disease), TVD (triple vessel disease), LAD (left anterior descending artery), RCA (right coronary artery), LCx (left circumflex artery), PTCA (percutaneous transluminal coronary angioplasty), CABG (coronary artery bypass grafting), AWMI (anterior wall myocardial infarction), IWMI (inferior wall myocardial infarction)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: October 18, 2018
Accepted:
October 17,
2018
Received in revised form:
September 28,
2018
Received:
July 14,
2018
Identification
Copyright
© 2018 Elsevier B.V. All rights reserved.
