Research Article| Volume 279, P45-51, December 2018

Download started.


Early onset ACS: An age based clinico-epidemiologic and angiographic comparison


      • 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.


      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.


      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.


      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).


      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



      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

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to Atherosclerosis
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


      1. Acute coronary syndrome. 2018;
        • Prabhakaran D.
        • Jeemon P.
        • Roy A.
        Cardiovascular cardiovascular diseases in India: current epidemiology and future directions.
        Circulation. 2016; 133: 1605-1620
        • Bhardwaj R.
        • Kandoria A.
        • Sharma R.
        Myocardial infarction in young adults-risk factors and pattern of coronary artery involvement.
        Niger. Med. J. 2014; 55: 44-47
        • Agrawal V.
        • Lohiya B.V.
        • Sihag B.K.
        • Prajapati R.
        Clinical profile with angiographic correlation in naïve acute coronary syndrome.
        J. Clin. Diagn. Res. 2016; 10: OC10-OC14
        • WHO
        Global Database on Body Mass Index., 2017
        • Hovingh G.K.
        • Davidson M.H.
        • Kastelein J.J.
        • O’ Connor A.M.
        Diagnosis and treatment of familial hypercholesterolaemia.
        Eur. Heart J. 2013; 34: 962-971
        • American College of Cardiology
        Left Ventricular Ejection Fraction LVEF Assessment (Outpatient Setting) - American College of Cardiology.
        • Gotsman I.
        • Lotan C.
        • Mosseri M.
        Clinical manifestations and outcome of acute myocardial infarction in very young patients.
        Isr. Med. Assoc. J. 2003; 5: 633-636
        • Soeiro Ade M.
        • Fernandes F.L.
        • Soeiro M.C.
        • Serrano C.V.J.
        • Oliveira M.T.
        Clinical characteristics and long-term progression of young patients with acute coronary syndrome in Brazil.
        Einstein (São Paulo). 2015; 13: 370-375
        • Puricel S.
        • Lehner C.
        • Oberhansli M.
        • Rutz T.
        • Togni M.
        • et al.
        Acute coronary syndrome in patients younger than 30 years – aetiologies, baseline characteristics and long-term clinical outcome.
        Swiss Med. Wkly. 2013; 143: w13816
        • Schoenenberger A.W.
        • Radovanovic D.
        • Stauffer J.C.
        • Windecker S.
        • Urban P.
        • et al.
        Acute coronary syndromes in young patients: presentation, treatment and outcome.
        Int. J. Cardiol. 2011; 148: 300-304
        • Hoit B.
        • Gilpin E.A.
        • Henning H.
        • Maisel A.A.
        • Dittrich H.
        • Carlisle J.
        • Ross Jr., J.
        Myocardial infarction in young patients: an analysis by age subsets.
        Circulation. 1986; 74: 712-721
        • Tsai W.C.
        • Wu K.Y.
        • Lin C.S.
        Clinical characteristics of patients less than forty years old with coronary artery disease in Taiwan: a cross-sectional study.
        Acta Cardiol. Sin. 2017; 33: 233-240
        • Twig G.
        • Yaniv G.
        • Levine H.
        • Leiba A.
        • Goldberger N.
        • Derazne E.
        • Ben-Ami Shor D.
        • Tzur D.
        • Afek A.
        • Shamiss A.
        • Haklai Z.
        • Kark J.D.
        Body-mass index in 2.3 million adolescents and cardiovascular death in adulthood.
        N. Engl. J. Med. 2016; 374: 2430-2440
        • Kaul U.
        • Dogra B.
        • Manchanda S.C.
        • Wasir H.
        • Rajani M.
        Myocardial infarction in young Indian patients: risk factors and coronary arteriographic profile.
        Am. Heart J. 1986; 112: 71-75
        • Chavan B.S.
        • Arun P.
        • Bhargava R.
        • Singh G.P.
        Prevalence of alcohol and drug dependence in rural and slum population of Chandigarh: a community survey.
        Indian J. Psychiatr. 2007; 49: 44-48
        • Choudhury L.
        • Marsh D.
        Myocardial infarction in young patients.
        Am. J. Med. 1999; 107: 254-261
        • Niccoli G.
        • Scalone G.
        • Crea F.
        Acute myocardial infarction with no obstructive coronary atherosclerosis: mechanisms and management.
        Eur. Heart J. 2015; 36: 475-481
        • Kardasz I.
        • De Caterina R.
        Myocardial infarction with normal coronary arteries: a conundrum with multiple aetiologies and variable prognosis: an update.
        J. Intern. Med. 2007; 261: 330-348