Clinical and Angiographic Characteristics, Therapeutic Strategies and Outcome of Young Patients with Acute Coronary Syndrome

Abstract

Clinical and Angiographic Characteristics, Therapeutic Strategies and Outcome of Young Patients with Acute Coronary Syndrome Background Patients with acute coronary syndrome have clinical differences which are determined by the age-group to which they belong. Yet, few studies have compared young patients versus elder patients presenting with this syndrome. Objectives To describe the clinical and angiographic characteristics, the therapeutic uses and the outcome of young patients with acute coronary syndrome, and to compare them with those of elder patients. Methods A total of 5,055 patients with diagnosis of acute coronary syndrome, included in the Epi-Cardio registry, were analyzed. Men ≤ 45 years and women ≤ 50 years were considered young. Results Young patients represented 10.3% of the population (519) and 89.7% (4,536) were elder patients. Among young patients, 49.9% presented ST-segment elevation acute coronary syndrome and 50.1% had non ST-segment elevation. In elder patients, ST-segment elevation acute coronary syndrome occurred in 38.4% and 61.6% had non ST-segment elevation (p <0,00001). Coronary angiography was performed to 2,845 patients (56.3%). Among young patients, 54.2%, 20% and 9.7% had one-vessel, two-vessel and three-vessel disease, respectively, and 16.1% had non-significant lesions. Among the elder, 39.6%, 28.4% and 22.5% had onevessel, two-vessel and three-vessel disease, respectively, and 9.5%% had non-significant lesions (p <0.001). There were no significant differences in the treatments used between both age groups during hospitalization. Mortality was of 1% in young patients and 3.5% in the elder (OR 0.26; p=0.02). Corrected mortality was significantly lower in young patients (OR 0.25; p=0.038). Conclusions ST-segment elevation acute coronary syndrome was more frequent among young patients compared to elder patients. Mortality was three to four times greater in elder patients. The difference in the clinical presentation is justified by the profile of cardiovascular risk and extension of coronary artery disease of both groups.