Clinical and Angiographic Profile of Acute Coronary Syndrome Patients (<40 Years) and Short-Term Prognosis

Abstract

Background: The rapidly changing economic stature and lifestyle choices of young individuals have affected healthcare in India. An increased prevalence of acute coronary syndrome (ACS) in young individuals has been observed. Aims and Objectives: The present cross-sectional, observational study was designed to record the clinical and angiographic profiles of young individuals (<40 years) with ACS. Materials and Methods: This cross-sectional, observational study was also designed to analyze the associations of lifestyle risk factors such as obesity, smoking, and alcohol on the occurrence of ACS and short-term (1 month) prognosis (rehospitalization and mortality). The inclusion criteria were age between 18 and 40 years with angina pectoris or equivalent at presentation and later diagnosed ACS per the consensus paper from the European Society of Cardiology/American College of Cardiology/American Heart Association/World Heart Federation joint task force. Patients with a previous history of ACS/coronary revascularization, atypical chest pain, valvular heart disease, hypertrophic cardiomyopathy, and/or congenital heart disease were excluded. Results: Out of the 403 patients that were screened, 162 young patients (18–40 years, mean ± standard deviation: 31.5 ± 4.64) were enrolled from a single tertiary cardiac care center located at Pune, Maharashtra, from May 2014 to May 2016. Most of the patient population were males (n [%]:151 [93.2]) of which 50% had positive addiction status for alcohol and smoking, family history of coronary artery disease (CAD) and a quarter of the patients had comorbidities of diabetes mellitus, hypertension, and/or abnormal lipid profile. The majority of the young ACS patients had ST-elevated myocardial infarction (STEMI: 87%), wherein anterior wall myocardial infarction was the most common electrocardiogram presentation, and primary angioplasty in myocardial infarction (PAMI) was the preferred modality of treatment in most of the young patients (61.7% vs. 38.3% thrombolysis). Conclusion: The prevalent angiographic profile of this study participants included obstructive CAD, single vessel disease, left ventricular ejection fraction (LVEF) <45, Angina Class IV, New York Heart Association (NYHA) class I, and Killip class I. Low LVEF, NYHA class IV, and Killip class IV showed association with short-term outcomes (mortality). The present study adds to the pool of information related to the western Indian population. However, a larger cohort study with a long-term follow is warranted to analyze the detailed ACS progression status in young individuals.