CLINICAL CHARACTERISTIC AND PROGRESSION OF ACUTE CORONARY SYNDROME IN YOUNG PATIENTS IN ADEN-YEMEN 2024-2025

The prevalence of acute coronary syndrome (ACS) has been rising in the younger population worldwide. Although less common than in older populations, is a serious condition with unique risk factors and presentations. This linked to the growing prevalence of traditional cardiovascular risk factors among younger people, such as type 2 diabetes, hypertension, obesity, and hyperlipidemia, which have led to a rise in atherosclerotic coronary artery disease (CAD). Additionally, emerging research points to the influence of less traditional risk factors, including chronic inflammation, autoimmune diseases, drug use, psychosocial factors, and novel biomarkers in the early onset of CAD. These factors collectively contribute to the rise in premature CAD, highlighting the need for improved prevention strategies and public health efforts focused on younger populations. The study aims to assess the characteristics and outcomes of ACS in young patients. A hospital- based descriptive cross-sectional study was conducted in 104 patients who were diagnosed and treated as ACS at private cardiac units of Aden-Germany Hospital in the period between April 2024 and January 2025 were studied with reference to clinical profile and risk factor analysis based on cardiac enzyme biomarkers and cardiac invasive and non- invasive assessments. The mean (± SD) age was) 28.8 ±09) years, 100 patients (96.2%) were male, 4(3.8%) were female. Smoking were with 56 (53.8%) and 48 (46.2%) were with Khat and shamma chewing risk factors. A high percentage of patients 90) 86.5% (presenting with chest pain, with vast majority being non- diabetic 79 (98.8%). 57 (95%) of myocardial infarction (MI) patients with elevated ST segment (STEMI) were male. Elevated troponin level was highly significance (p value = 0.001). Most patients were with mild left ventricular ejection fraction and single coronary artery vessel affected (35.6%, 60.8% respectively). Killip class I represent the majority (61.5%) with a significance proportion (66.7%) were under the age of 30 and had non-elevated ST- segment (79.5%). The majority of the patients were male. Smoking, Kat and shamma chewing presumed risk factors. Killip class I and elevated ST segment quite common.

oronary heart disease is the leading cause of mortality and morbidity in industrialized countries, in men as well as in women.Women have their first cardiac event 6 to 10 years later than men do.Whereas the cardiovascular death rates are declining in men, they remain constant in women.In cardiovascular studies with age limits, women are naturally the minority, amounting to Ͻ40%.It is well known that distinct gender differences exist in terms of presentation of symptoms, validity of diagnostic tests, drug side effects, and complications.With respect to cardiac risk factors, women have higher rates of diabetes and hypertension but are less frequently smokers.

The prevalence of acute coronary syndrome (ACS) in young adults (<40 years) is rising, with a substantial proportion attributable to non-atherosclerotic causes. One cause is essential thrombocythemia (ET), a myeloproliferative neoplasm (MPN) characterized by increased risk of thrombosis and bleeding. Recognizing ET as an aetiology of ACS is clinically important, as it alters acute and long-term management. This case highlights myocardial infarction as the presenting event of JAK2-positive ET in a young patient without traditional risk factors. A 31-year-old man with no cardiovascular risk factors developed severe chest pain while weightlifting. ECG revealed anterior ST-segment elevation, and troponin peaked above 22 500 ng/L. Point-of-care ultrasound showed apical wall motion abnormality, and suprasternal notch view revealed no intimal flap. Coronary angiography showed complete ostial left anterior descending artery occlusion, treated with intravascular ultrasound-guided drug-eluting stent placement. Persistent thrombocytosis after reperfusion and at follow-up, along with absence of other risk factors, prompted haematology consultation. Hypercoagulability testing revealed a JAK2 V617F mutation. ET was confirmed by bone marrow biopsy, and hydroxyurea was initiated alongside standard post-infarction therapy. The patient recovered left ventricular function. This case highlights the importance of considering MPNs as a potential cause of ACS in young patients without traditional cardiovascular risk factors. Management of ET-associated ACS is complex, requiring careful balance of thrombosis prevention and bleeding risk. Cytoreduction with hydroxyurea is key to secondary prevention. Current ACS guidelines do not specifically address ET-associated ACS, underscoring the need for further studies in this high-risk population.

Despite significant advancements in the primary and secondary prevention of cardiovascular disease, evidence shows a rising incidence of premature coronary artery disease (CAD) and myocardial infarction (MI) in patients aged < 50 years. This increase is linked to the growing prevalence of traditional cardiovascular risk factors among younger people, such as type 2 diabetes, hypertension, obesity, and hyperlipidaemia, which have led to a rise in atherosclerotic CAD. Additionally, emerging research points to the influence of less traditional risk factors, including chronic inflammation, autoimmune diseases, drug use, psychosocial factors, and novel biomarkers in the early onset of CAD. These factors collectively contribute to the rise in premature CAD, highlighting the need for improved prevention strategies and public health efforts focused on younger populations. In this review, we explore the aetiology, risk factor profile, role of novel biomarkers, and how each of these impact outcomes among younger patients with MI.

Management of Acute Coronary Syndromes

Identifying the Vulnerable Patient with Rupture-Prone Plaque

Elevated lipoprotein(a) [Lp(a)] is an independent risk factor for coronary artery disease (CAD). However, its role in real-world practice and implications for clinical care remains limited. Under investigation herein, are the clinical characteristics associated with increased Lp(a) levels in patients presenting with acute coronary syndrome (ACS). Lp(a) was measured at admission in patients ≤ 65 years of age presenting with ACS in a single center. Logistic regression model was used to determine the independent association of clinical characteristics with elevated Lp(a). A total of 134 patients were screened for Lp(a); 83% males, mean age 52 ± 8 years. Median Lp(a) level was 46 nmol/L (interquartile range [IQR] 13-91). Elevated Lp(a) > 72 nmol/L (30 mg/dL) was documented in 32% and associated with younger age at CAD diagnosis. In a multiple logistic regression model, premature CAD (odds ratio [OR] 3.85, 95% confidence interval [CI] 1.48-10.07, p = 0.06), previous revascularization (OR 2.56, 95% CI 1.17-5.59, p = 0.019) and probable/definite familial hypercholesterolemia (FH) (OR 3.18, 95% CI 1.10-9.21, p = 0.033), were independently associated with elevated Lp(a). In contrast, Lp(a) levels were not associated with other traditional cardiovascular risk factors, previous statin treatment, C-reactive protein level or ACS type. In young and middle-aged patients presenting with ACS, premature CAD, previous revascularization and FH were independently associated with elevated Lp(a), indicating progressive CAD and higher cardiovascular risk. These results, are in accordance with guideline based recommendations for Lp(a) screening, and may be of importance in addressing residual cardiovascular risk in young ACS patients, in light of the novel emerging therapies targeting Lp(a).

Management of Acute Coronary Syndromes

BackgroundThere is dearth of literature addressing early outcomes of acute coronary syndrome (ACS) among young patients, particularly South Asians descent who are predisposed to premature coronary artery disease (CAD). Therefore, we compared presentation, management, and early outcomes of young vs. old ACS patients and explored predictors of in-hospital mortality.MethodsWe extracted data of 23,560 ACS patients who presented at Tabba Heart Institute, Karachi, Pakistan, from July 2012-June 2020, from the Chest pain-MI-Registry™. We categorized data into young ≤ 45 and old ACS patients > 45 years. Chi-sq/Fischer exact tests were used to assess the difference between presentation, disease management, and in-hospital mortality between both groups. Logistic regression was used to determine odds ratio along with 95% confidence interval of factors associated with early mortality.ResultsThe younger patients were 12.2% and women 23.5%. The prevalence of dyslipidemia (34.5% vs. 22.4%), diabetes (52.1% vs. 27.4%), and hypertension (68.3% vs. 42.9%) was higher in older patients. Family history of premature CAD (18.1% vs. 32.7%), smoking (40.0% vs. 22.9%), and smokeless tobacco use (6.5% vs. 8.4%) were lower in older patients compared to younger ones. Younger patients were more likely to present with STEMI (33.2% vs. 45%). The median symptom-to-door time was 125 min longer (p-value < 0.01) in the young patients compared to the older age group. In-hospital mortality (4.3% vs. 1.7%), cardiac arrest (1.9% vs. 0.7%), cardiogenic shock (1.9% vs. 0.9%), and heart failure (1% vs. 0.6%) were more common in older patients. After adjusting for other factors, younger age (AOR 0.6, 95% CI 1.5–3.7) had significantly lesser odds of in-hospital mortality. Other factors associated with early mortality included women, family history of premature CAD, STEMI, Killip class III and IV, coronary angiography, revascularization, CABG, and use of aspirin and beta blockers within the first 24 h.ConclusionWe found every tenth ACS patient was younger than 45 years of age despite a lesser number of comorbidities such as hypertension and diabetes. Overall, the in-hospital prognosis of young patients was more favorable than that of older patients. The study emphasizes the need for tailored primary prevention programs for ACS, considering the varying risks among different age groups.

Objective The purpose of this study was to better understand the impact of a preexisting diagnosis of rheumatoid arthritis (RA) on patient hospital outcomes in acute coronary syndrome (ACS) in comparison to traditional ACS risk factors. Methods This retrospective study protocol included 673 patients hospitalized with ACS in the HCA Healthcare West Florida Division from January 1, 2016, to December 31, 2023. Analysis via logistic regression and negative binomial regression compared associations between patients with ACS as primary diagnostic codes during their hospital admissions who also had RA, considering demographics like age, sex, and race. Patient encounters and diagnoses were identified using ICD-10 codes. Regression models were used for our analysis due to the straightforward computation, increased reproducibility, ability to use both categorical and continuous variables, and capability to convert diagnostic codes into binary variables. Traditional risk factors for ACS were also included in multivariate analyses. These included current tobacco use, former tobacco use, alcohol use disorder, elevated BMI, hyperlipidemia (HLD), and diabetes mellitus (DM). Pregnant patients, patients below 18 years of age, patients missing demographic information, and patients with other autoimmune conditions were excluded from the study. Results For RA, the odds of in-hospital mortality were not significantly 0.779 times as likely (p-value 0.2252, 95% CI (0.520, 1.167)), and 30-day readmission odds were not significantly 0.948 times as likely (p-value 0.5671, 95% CI (0.789, 1.139)). RA resulted in a 1.034-factor statistically insignificant increase in length of stay (LOS) (p-value 0.3369, 95% CI (0.965, 1.108)). For the traditional risk factors, odds of in-hospital mortality were 1.071 times as likely for every one-year increase in age (p-value <0.0001, 95% CI (1.065, 1.077)), 1.285 times as likely for current smokers (p-value 0.0020, 95% CI (1.096, 1.507)), 0.970 times as likely for every one-point increase in BMI (p-value <0.0001, 95% CI (0.961, 0.980)), 0.647 times as likely for patients with HLD (p-value <0.0001, 95% CI (0.576, 0.726)), and 1.349 times as likely for patients with DM (p-value <0.0001, 95% CI (1.212, 1.502)). Age, DM, and alcohol use disorder resulted in statistically significant increased 30-day readmission. Age, male sex, Black race, other non-Caucasian races, former tobacco use, current tobacco use, DM, and alcohol use disorder resulted in statistically significant increased LOS. Conclusions RA was surprisingly associated with decreased in-hospital mortality and 30-day readmission in the setting of ACS despite an associated increased LOS, which needs to be investigated further. In terms of statistical significance, there was no difference in these outcomes in patients with RA versus patients without RA. HLD was unexpectedly associated with a significant decrease in in-hospital mortality, which requires further investigation. Meanwhile, the traditional risk factors, except BMI and HLD, continued to show worse outcomes with statistical significance in the same patient population. Longitudinal follow-up and further clinical investigation of these patient encounters will likely shed more light on these associations. This knowledge may prevent over-utilization of time, equipment, and resources when addressing hospitalized patients with RA presenting with ACS, particularly in acute care settings.

BACKGROUND AND OBJECTIVESGender associations with acute coronary syndrome (ACS), remain inconsistent. Gender-specific data in the Saudi Project for Assessment of Coronary Events registry, launched in December 2005 and currently with 17 participating hospitals, were explored.DESIGN AND SETTINGSA prospective multicenter study of patient with ACS in secondary and tertiary care centers in Saudi Arabia were included in this analysis.PATIENTS AND METHODSPatients enrolled from December 2005 until December 2007 included those presented to participating hospitals or transferred from non-registry hospitals. Summarized data were analyzed.RESULTSOf 5061 patients, 1142 (23%) were women. Women were more frequently diagnosed with non ST-segment elevation myocardial infarction (NSTEMI [43%]) than unstable angina (UA [29%]) or ST-segment elevation myocardial infarction (STEMI [29%]). More men had STEMI (42%) than NSTEMI (37%) or UA (22%). Men were younger than women (57 vs 63 years) who had more diabetes, hypertension, and hyperlipidemia. More men had a history of coronary artery disease. More women received angiotensin receptor blockers (ARB) and fewer had percutaneous coronary intervention (PCI). Gender differences in the subset of STEMI patients were similar to those in the entire cohort. However, gender differences in the subset of STEMI showed fewer women given β-blockers, and an insignificant PCI difference between genders. Thrombolysis rates between genders were similar. Overall, in-hospital mortality was significantly worse for women and, by ACS type, was significantly greater in women for STEMI and NSTEMI. However, after age adjustment there was no difference in mortality between men and women in patients with NSTEMI. The multivariate-adjusted (age, risk factors, treatments, door-to-needle time) STEMI gender mortality difference was not significant (OR=2.0, CI: 0.7–5.5; P=.14).CONCLUSIONThese data are similar to other reported data. However, differences exist, and their explanation should be pursued to provide a valuable insight into understanding ACS and improving its management.

Background Coronary artery disease (CAD), which clinically manifested as an acute coronary syndrome (ACS) is an important extrahepatic cardiovascular complication of non-alcoholic fatty liver disease (NAFLD). To date, little is known about the correlation between young patients with ACS and NAFLD. Aim to assess the correlation between NAFLD and severity of CAD in young ACS patients and determine the prevalence of NAFLD in this cohort. Methods This cross-sectional study included young (45 years and less) ACS patients. Coronary angiogram was performed to assess CAD severity, and complexity determined by SYNTAX score. CAD severity was classified into: no apparent CAD, mild CAD, single vessel disease (SVD) and multi-vessel disease (MVD). Liver ultrasound was used to diagnose and grade the NAFLD (grade 1–3). NAFLD fibrosis score (NFS) was calculated, and patients were stratified to low, indeterminate, and high probability for advanced liver fibrosis. Results Total of 85 patients with median age of 40 years (IQR 35–43) and predominated by males (84.7%). Thirty-three (38.9%) had ST elevation myocardial infarction (STEMI), 32 (37.6%) had Non-STEMI and 20 (23.5%) had unstable angina. MVD was demonstrated in 36.5%, SVD in 24.7%, mild CAD in 31.8%, and no apparent CAD in 7.1% of the patients. Median Syntax score was 16 (IQR 9.0–22.3). NAFLD was diagnosed in all, 85 (100%) patients, with 13 (15.2%), 36 (42.4%) and 36 (42.2%) patients had grade 1, 2 and 3 liver steatosis respectively. NFS detected low advanced fibrosis probability in 60 (70.6%) patients, indeterminate probability in 24 (28.2%) patients and high probability in only 1 (1.2%) patient. No significant correlation between grades of NAFLD with ACS subtypes (p=0.72), severity of CAD (p=0.882) and SYNTAX score (p=0.982). No significant association between NFS and ACS subtypes (p=0.232), severity of CAD (p=0.445) and SYNTAX score (p=0.624, r=0.07). Conclusions NAFLD is highly prevalent in young patients presented with ACS, and it should be routinely screened in our clinical practice. However, in a small cohort, we observed no significant correlation between severity of NAFLD and severity of CAD among young ACS patients.

BackgroundThe prevalence of acute coronary syndrome (ACS) continues to increase among young Chinese adults. Homocysteine (HCY) has been suggested as a promoter of atherosclerosis leading to coronary artery disease (CAD). Yet, it remains uncertain whether HCY is associated with the ACS and the severity of coronary artery stenosis in young adults.MethodsYoung patients (18–35 years of age) diagnosed with ACS who underwent coronary angiography (CAG) at Anzhen Hospital between January 2013 and June 2019 were assigned to the ACS group. As confirmed by CAG during the same period, an equivalent age-matched population without CAD was assigned to the non-CAD group. A serum HCY level > 15 µmol/L was defined as hyperhomocysteinemia (HHCY). The Gensini score assessed the severity of coronary artery stenosis.ResultsA total of 1103 participants, including 828 ACS patients and 275 non-CAD subjects, were enrolled in this study. Young ACS patients had higher level of serum HCY and greater prevalence of HHCY compared with non-CAD subjects [for HCY, 16.55 (11.93–29.68) vs 12.50 (9.71–17.42), P < 0.001; for HHCY prevalence, 62.08% vs 26.18%, P < 0.001]. Multivariate logistic regression analysis with the stepwise method indicated that HHCY was an independent predictor associated with the presence of ACS, after adjusting for traditional confounders (OR, 4.561; 95% CI, 3.288–6.327; P < 0.001). Moreover, young ACS patients with HHCY had increased prevalence of ST-segment elevation myocardial infarction (STEMI) (P = 0.041), multi-vessel disease (P = 0.036), and decreased value of left ventricular ejection fraction (LVEF) (P = 0.01). Also, the HCY level was significantly correlated with Gensini Score in ACS patients (r = 0.142, P < 0.001).ConclusionHHCY is significantly associated with the presence of ACS and the severity of coronary artery stenosis in young adults ≤ 35 years of age.

Background and AimsThe prevalence of acute coronary syndrome (ACS) has been rising in the younger population worldwide. To fully comprehend the effects of the condition, it is crucial to examine the evolving characteristics and treatment options. The purpose of this study is to evaluate the characteristics and treatment analysis for young ACS patients in a tertiary care setting.MethodsThis cross‐sectional, retrospective, single‐center study included a random sample of patients who had been hospitalized for ACS over the period of a year. We collected and analyzed data on risk factors, diagnoses, angiographic patterns, and potential treatments.ResultsThe study involved 198 young ACS patients in total. The majority of patients (57%) had no risk factors, and the majority of them (44%) had ST‐elevation myocardial infarction (STEMI) as their diagnosis. The most common type (48%) was single‐vessel disease (SVD). Statins and antiplatelet medications made up the majority of the patients’ nonsurgical treatments (88% and 87%, respectively). A statistically significant difference exists between young and older ACS patients with gender (p < 0.01). However, it is not clinically relevant.ConclusionMen were the majority of young ACS patients, and STEMI, SVD were more prevalent. The majority of young ACS patients had no significant risk factors. To determine the risk factors of young ACS patients, a more thorough case–control study is critically needed.

792 Acute Coronary Syndrome in Patients With Normal or Non-Obstructive Coronary Artery Disease: Patient Characteristics and Long-Term Outcomes