Abstract
BACKGROUND: Coronary artery disease (CAD) occurring in less than 45 years of age is termed as premature CAD (PCAD). Recent studies showed a prevalence of 4-10 % of PCAD. PCAD is associated with unfavorable outcomes for the patients and had a greater impact on the quality of life. Family History is the best method to explained complex interaction between shared risk factor. CASE ILLUSTRATION: A 37-years old male admitted to Saiful Anwar Hospital for further evaluation of anginal pain. The patient complains of recurrent chest pain since 5 months ago but still relieved by rest. The electrocardiogram showed Wellens Type B which is specific for critical stenosis of the left anterior descending artery (LAD). Then the patient undergoing DCA Ad Hoc. The implantation of a 46 mm DES at proximal until distal LAD was performed. The patient discharged after a day observation. DISCUSSION: The challenging point, in this case, was it happen at a young age with strong family history. There was positive family history of PCAD in 1st degree relative on her brother and mother, despite several risk factors were identified in this case consist of smoking, and dyslipidemia, which make CAD risk higher. Despite adequate control of risk factors, family screening is important to reveal subclinical atherosclerosis. CONCLUSION: Approach to a patient with PCAD comprises of management of traditional risk factors and careful investigation of Family History. Individual with positive family history of PCAD should be treated more cautiously
Highlights
Cardiovascular disease (CVD) is the most common cause of mortality worldwide, with Asia accounting for half of all CVD cases
Premature coronary artery disease (PCAD) is described as a form of coronary artery disease that develops in women and men under the age of 55 and 45, respectively
Multiple stenoses were found from the proximal to the distal Left Anterior Descending (LAD) Artery, with critical stenosis of 99% at the mid left anterior descending (LAD) and 80% at the proximal LAD
Summary
Cardiovascular disease (CVD) is the most common cause of mortality worldwide, with Asia accounting for half of all CVD cases. Coronary artery disease (CAD) mortality has declined globally, it is still relatively high in several developing countries.[1] In Indonesia, CAD and stroke are estimated to cause more than 470.000 deaths annually.[2]. 10% of acute myocardial infarction (MI) cases occur before 40 years old, with all patients having a family history and history of smoking. Myocardial infarction, angioplasty, or coronary artery bypass surgery in a sibling, uncle or aunt, parent, or grandparent was considered a positive family history (excluding cousins, relatives by marriage, and half-relatives).[6,7] The percentage of patients who have a positive family history ranges from 14% to 69%. There is the utility of family history in terms of the CAD predictive model
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