Acute coronary syndrome in very young adults (<35 years of age) - time to awake and act! A prospective analytical study from South India
DOI:
https://doi.org/10.18203/2320-6012.ijrms20241880Keywords:
Acute coronary syndrome, Precocious ACS, South India, Very young adultsAbstract
Background: Acute coronary syndrome in very young adults (<35 yrs) was considered as an uncommon entity, recently shows rising incidence especially in India. Hence we planned this study with the aim, to investigate the incidence, clinical, angiographic profile and outcome of ACS in this population.
Methods: This is a prospective analytical study included patient <35 yrs with ACS admitted to cardiology department in a tertiary hospital of South India. Risk factors, clinical, angiographic profile and follow up data were recorded and analyzed.
Results: Among the total 2180 patients with ACS, 5.8% (n=127) were very young adults. Youngest one was 11 yrs old with coronary anomaly. Median age was 30yrs (SD±3) and only 8.6% (n=10) were obese. Smoking, male sex were the major conventional risk factors followed by low HDL (52%). Family history of premature coronary event seen in 12.9%, hyperhomocysteinemia, elevated LPA and high fibrinogen were observed in 15%, 20% and 3.5% respectively. Anterior wall MI with LAD occlusion was the commonest type (66.3%). Angiographically 31.4% (36/116) had recanalised vessels, coronary anomaly was seen in 3 (2.5%) patients and pure ectasia in 4 (3.4%) patients. Only 2 were undergone primary PCI (1.7%), 61% (n=71) received thrombolytic therapy. Median delay for angiogram was 72 hrs (3 days). In-hospital mortality was 3.4% and 4.5% (n=5) during follow up.
Conclusions: The incidence of ACS among very young adults is on the rising trend (5.8%). Obstructive CAD in 56.9% patients implies the rapid progression of atherosclerosis. With little contribution of novel risk markers of atherosclerosis, smoking and dyslipidemia accelerate the process of premature vascular aging in Indian subcontinent.
Metrics
References
World Health Organization. Global Status Report on Noncommunicable Diseases, 2014. Available at: https://iris.who.int/bitstream/handle/10665/148114/9789241564854_eng.pdf?sequence=1. Accessed 01 March 2024.
Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet. 2004;364(9438):937-52.
Sharma M, Ganguly NK. Premature coronary artery disease in Indians and its associated risk factors. Vasc Health Risk Manag. 2005;1(3):217-25.
Sinha SK, Krishna V, Thakur R, Kumar A, Mishra V, Jha MJ, et al. Acute myocardial infarction in very young adults: a clinical presentation, risk factors, hospital outcome index, and their angiographic characteristics in North India-AMIYA Study. ARYA Atheroscler. 2017;13:79-87.
Care D. Standards of medical care in diabetes 2019. Diab Care. 2019;42(Suppl 1):S124-38.
Mathur KS. Environmental factors in coronary heart disease: an epidemiologic study at Agra (India). Circulation. 1960;21(5):684-9.
Krishnan MN, Zachariah G, Venugopal K, Mohanan PP, Harikrishnan S, Sanjay G, et al. Prevalence of coronary artery disease and its risk factors in Kerala, South India: a community-based cross-sectional study. BMC Cardiovasc Disord. 2016;16(12):1-2.
Begom R, Singh RB. Prevalence of coronary artery disease and its risk factors in the urban population of South and North India. Acta Cardiolog. 1995;50(3):227-40.
Davidson L, Wilcox J, Kim D, Benton S, Fredi J, Vaughan D. Clinical features of precocious acute coronary syndrome. Ame J Medi. 2014;127(2):140-4.
Berenson GS, Srinivasan SR, Bao W, Newman WP, Tracy RE, Wattigney WA. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Medi. 1998;338(23):1650-6.
Tuzcu EM, Kapadia SR, Tutar E, Ziada KM, Hobbs RE, McCarthy PM, et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults: evidence from intravascular ultrasound. Circulation. 2001;103(22):2705-10.
Glover MU, Kuber MT, Warren SE, Vieweg WV. Myocardial infarction before age 36: risk factor and arteriographic analysis. Ame J Cardiol. 1982;49(7):1600-3.
Sricharan KN, Rajesh S, Rashmi, Meghana HC, Badiger S, Mathew S. Study of acute myocardial infarction in young adults: Risk factors, presentation and angiographic findings. J Cli Diagnos Res. 2012;6(2):257-60.
Garoufalis S, Kouvaras G, Vitsias G, Perdikouris K, Markatou P, Hatzisavas J, et al. Comparison of angiographic findings, risk factors, and long term follow-up between young and old patients with a history of myocardial infarction. Int J Cardiol. 1998;67(1):75-80.
Christus T, Shukkur AM, Rashdan I, Koshy T, Alanbaei M, Zubaid M, et al. Coronary artery disease in patients aged 35 or less-a different beast?. Heart Views. 2011;12(1):7-11.
Kalimuddin M, Ahmed N, Badiuzzzaman M, Ahmed MN, Dutta A, Banik D, et al. AMI in very young (aged≤ 35 years) Bangladeshi patients: Risk factors & coronary angiographic profile. Clin Tri Regul Sci Cardiol. 2016;13:1-5.
Højland Ipsen D, Tveden‐Nyborg P, Lykkesfeldt J. Normal weight dyslipidemia: is it all about the liver?. Obesity. 2016;24(3):556-67.
Rallidis LS, Pavlakis G, Foscolou A, Kotakos C, Katsimardos A, Drosatos A, et al. High levels of lipoprotein (a) and premature acute coronary syndrome. Atheroscl. 2018;269:29-34.
Zairis MN, Adamopoulou EN, Manousakis SJ, Lyras AG, Bibis GP, Ampartzidou OS, et al. The impact of hs C-reactive protein and other inflammatory biomarkers on long-term cardiovascular mortality in patients with acute coronary syndromes. Atheroscl. 2007;194(2):397-402.
Pineda J, Marín F, Marco P, Roldán V, Valencia J, Ruiz-Nodar JM, et al. Premature coronary artery disease in young (age< 45) subjects: interactions of lipid profile, thrombophilic and haemostatic markers. Int J Cardiol. 2009;136(2):222-5.
Downloads
Published
How to Cite
Issue
Section
