Coronary Syndrome In Young Adults Research Articles

Spontaneous Coronary Artery Dissection: A Difficult Journey from Emergency Coronary Artery Bypass Grafting to Left Ventricular Assist Device

Abstract Background Excluding spontaneous coronary artery dissection (SCAD) as an etiology of acute coronary syndrome in young adults is imperative. Case Summary A previously healthy 39-year-old woman experienced sudden severe chest pain, ST-segment elevation on ECG, necessitating high-dose aspirin and urgent transfer to a revascularization center. Suffering ventricular tachycardia (VT) and ventricular fibrillation (VF), she underwent two rounds of advanced life support and venoarterial extracorporeal membrane oxygenation (VA-ECMO). Diagnosed with left main coronary artery (LMCA) SCAD, she was initially started on conversative therapy for declining left ventricular ejection fraction (LVEF). However, she continue to experience an escalating anginal symptoms, worsening biomarkers, and LMCA SCAD progression which urged the need for surgical intervention with coronary artery bypass graft surgery (CABG). Following her CABG, she experienced a worsening of her functional mitral regurgitating which she underwent transcatheter edge-to-edge repair (TEER) of her severe mitral regurgitation. Despite being listed for heart transplantation (OHTx), her low body mass index and elevated antibodies necessitated HeartMate III left ventricle assist device (LVAD) for bridge-to-transplant. Treating frequent ventricular tachycardia (VT) episodes with medications, she eventually received an LVAD as a bridge to cardiac transplantation, navigating through complications. Within one year of her receiving LVAD, she underwent a successful OHTx. Discussion The pathogenesis of SCAD involves intramural hematoma formation through intimal tears or vasa vasorum hemorrhage. Adverse outcomes in the patients described, characterized by cardiac arrest, cardiogenic shock, reduced left ventricle systolic function and occasionally serious cardiac arrhythmia – such as ventricular fibrillation – which can lead to sudden cardiac death. Although most SCAD cases heal spontaneously, revascularization can be considered in case of worsening SCAD progression. Advanced therapeutic intervention including mechanical circulatory support and OHTx should considered in refractory cases.

Associations between hyperhomocysteinemia and the presence and severity of acute coronary syndrome in young adults\u2009\u2264\u200935\xa0years of age

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.

Clinical and angiographic features of acute coronary syndrome in young adults: A Tunisian Cohort

Acute coronary syndrome (ACS) in young adults seems to be not as low as expected. It presents one of the highly debated issues in cardiology according to the increasing number of those patients. The aim of our study was to describe the clinical and angiographic profile in young patient ≤ 40 years diagnosed with ACS. We performed a retrospective study including 74 patients younger than 40 years of age with clinical and electrocardiographic evidence of ACS, hospitalized in our cardiology department from January 2016 to Mach 2019. All patients underwent a coronary angiography. We analyzed the risk factors, clinical profile, type of ACS and angiographic features of these patients. Mean age was 33 ± 7 years old [26-40] and 94% of them were males (five women versus 70 men). All men were smokers, including four man addicted on cannabis, and only two women were non-smokers. The most common risk factors were diabetes mellitus (14 patients; 19%), systemic hypertension (10 patients; 13.5%), dyslipidemia (7 patients; 9.4%), obesity (7 patients; 9.4%) and a family history of premature coronary artery disease (5 patients; 6.7%). Ten patients (13.5%) were having ST segment elevation myocardial infraction, 13 patients (17.5%) were hospitalized for a non-ST segment elevation and 51 patients (69%) have a history of an unstable angina. The most common abnormal arteriography findings were the involvement of one vessel (23 patients; 31%), followed by double-vessel disease noticed in two cases (2.7%). There was one patient of our population with three-vessel disease (1.3%). The most common vessel to be involved was the left anterior descending (12 cases; 16%). Normal coronary angiography was noticed in 37 patients (50%). ACS in young patients has a huge impact on the patient, the society and the economic burden. It presents a real challenge that the cardiologist must be aware of in order to set on the ideal therapeutic strategy including the perfect clinical management and an early prevention program to control the cardiovascular risk factors.

Major risk factors for developing acute coronary syndrome in young adults

Aim . To study the factors associated with the development of acute coronary syndrome in young adults. Methods . 299 patients with acute coronary syndrome (ACS) aged 25 to 44 years admitted to the Cardiology Department at the Regional Government Budgetary Healthcare Institution “Altai Regional Cardiology Dispensary” were enrolled in the study. The mean age of patients was 40.3±0.2 years. The control group included 53 healthy subjects without cardiovascular diseases aged 25 to 44 years (the mean age of 39.9±0.79 years). Traditional risk factors were assessed in all patients. CBC and blood biochemistry were performed in all patients to determine lipid profile and fasting glucose levels. Additionally, height and weight were measured with the subsequent calculation of the body mass index. Patients with ACS underwent electrocardiography, echocardiography, coronary angiography. Gene polymorphisms FII G20210A, FV G1691A, MThFr C677T were evaluated by polymerase chain reaction in 116 young adults present with ACS and 53 healthy volunteers. Results . Based on the comprehensive assessment of the clinical and demographic data, traditional risk factors and hemostatic and folate metabolism gene polymorphisms assessment in young adults, the most significant risk factors associated with the development of ACS in young patients included smoking, elevated low-density lipoprotein cholesterol with the presence of FV G1691A heterozygous polymorphism. The obtained findings could be effectively used in clinical practice to determine patients at high risk of cardiovascular diseases. Conclusion . Thus, screening for high risk of cardiovascular diseases among young adults should include genetic testing of FV G1691A and MTHFR C677T gene polymorphisms along with traditional risk factors to introduce additional examinations and employ novel preventive strategies.

Clinical profile of acute coronary syndrome in young adults : A single centre study

Clinical profile of acute coronary syndrome in young adults : A single centre study

Atherosclerotic disease is the predominant aetiology of acute coronary syndrome in young adults.

SummaryObjectivesFew studies have evaluated young adults in their third and fourth decades with coronary artery disease (CAD). This study evaluated the clinical and angiographic profile of young adults (< 35 years) with CAD.MethodsA 10-year (2003–2012) retrospective chart reviewwas performed on patients less than 35 years diagnosed withCAD at Inkosi Albert Luthuli Central Hospital, Durban.ResultsOf the 100 patients who met the study criteria, the majority were male (90%), of Indian ethnicity (79%), and presented with acute coronary syndrome (93%). Smoking (82%), dyslipidaemia (79%) and dysglycaemia (75%) were the most prevalent risk factors. Almost half of the subjects (48%) met criteria for the metabolic syndrome. Angiographic findings revealed multi-vessel (42%), single-vessel (36%) and non-occlusive disease (20%); only two subjects had normal epicardial vessels. Disease severity was influenced by dyslipidaemia (p = 0.002) and positive family history (p = 0.002). Non-coronary aetiologies were identified in 19% of subjects.ConclusionsAtherosclerotic disease associated with risk-factor clustering was highly prevalent in young adults with CAD.

Body Mass Index and Waist Circumference as Predictive Factors in the Development of Acute Coronary Syndrome in Young Adults

Body Mass Index and Waist Circumference as Predictive Factors in the Development of Acute Coronary Syndrome in Young Adults

Body Mass Index and Waist Circumference as Predictive Factors in the Development of Acute Coronary Syndrome in Young Adults

Body Mass Index and Waist Circumference as Predictive Factors in the Development of Acute Coronary Syndrome in Young Adults

Clinical Profile of Acute Coronary Syndrome in Young Adults

Clinical Profile of Acute Coronary Syndrome in Young Adults

Clinical profile of acute coronary syndrome in young adults of north Indian population

Clinical profile of acute coronary syndrome in young adults of north Indian population

Español

ABSTRACT Introduction: Acute coronary syndrome in youngers than 45 years old constitutes a clinical condition with specific characteristics that tells it apart from older patients because the poor symptomatology previous to the origin of the acute coronary syndrome and the presence of peculiars risk factors such as connective tissue disorders, hypercoagulability states and the drugs intake, leads to lesser complications and better prognosis. Objective: characterize the acute coronary syndrome in young adults admitted at the Cardiology and Surgery Cardiovascular’s Institute between the years 2013 and 2014. Materials and Methods: Descriptive and transverse study with 99 patients under 45 years old who had acute coronary syndrome. There were analyzed clinical variables, diagnostic and therapeutic strategies. Results: The mean age was 42 years and the masculine sex was predominant. Smoking, arterial hypertension and dyslipidemia were the risk factors more common. The typical pain was in the 70.7% of patients. Electrocardiographic disorders of the inferior region (33.3%) and previous (22.2%) were the more frequents. The normal ejection fraction of the left ventricle (22.2%) predominated in the one vessel disease. The hypokinesia (48.5%) and akinesia (26.3%) predominated in this syndrome. The most responsible arteries were the descending previous (40.4%) and the right coronary (28.3%). The coronary percutaneous intervention was the procedure more made in acute coronary syndrome with ST segment elevation. Conclusions: The minimum extension of the coronary disease justified the conservation of the ventricular function, the segmentary hypokinesia and the softly percent of complications. The coronary percutaneous intervention constituted the strategy of re-perfusion more used in the acute coronary syndrome with elevation of the segment ST. MED UIS. 2015;28(3):281-90. Key words: Young adult. Acute coronary syndrome. Systolic volume. Segmentary motility. Percutaneous coronary intervention

Abstract 202: Emergence and Characterization of Premature Acute Coronary Syndrome in Young Adults with a Confirmed History of Kawasaki Disease in Japan: Clinical and Mechanistic Insight.

Background: Sporadic cases of acute coronary syndrome (ACS) have been reported in adults with coronary sequelae presumably due to Kawasaki disease (KD). However, ACS in adults with a confirmed (whether followed-up or lost to follow-up) as well as unconfirmed history of KD is poorly characterized. Methods: To investigate ACS in such adults after KD during 2000-10, a nationwide survey was conducted in Japan. Results: A total of 67 patients (median age 35 yo, male 76%) were recruited. A diagnosis of KD was made in 32 during acute illness (Group A), in which 17 were lost to follow up. A KD diagnosis was made retrospectively in the other 35 patients from coronary imaging at ACS (Group B). Overall, 67 patients were characterized by demonstrable thrombosis (74%) as well as the presence of giant aneurysms (GAN) (≥8mm) (38%), severe stenosis (&gt;75%) (38%) and IVUS-derived calcification (92%) in culprit lesions. Group A represented younger age at ACS (26.5 yo vs. 40 yo in group B, p&lt;.001), lower conventional coronary risks (87% vs 65%, p=.043), low percentage of severe stenosis (25% vs. 50%, p=.302) and high proportion of IVUS-derived calcification (86% vs. 100%, p=.335). In group A, patients who were followed up before ACS represented a higher proportion of GAN in culprit lesions (69% vs. 29% in KD patients lost to follow up, p=.030) as well as a shorter interval from acute KD (20 y vs. 27 y, p=.008) and higher percentage of medication before ACS (87% vs. 0%, p&lt;.001). In the convalescence of acute KD in group A, the vessel size of prospective culprit lesion was 6.0-7.9mm in 36% and ≥8mm in 64%. Coronary angio, IVUS and MDCT of cases in 3 categories are presented. Conclusions: Premature ACS in young adults with a confirmed history of KD, significant coronary sequelae just after acute KD and low coronary risks is emerging in Japan. ACS in this population comprises two subtypes: ACS with GAN in culprit lesions in adults followed up for KD, as in childhood myocardial infarction in KD, and ACS in adults lost to follow up, characterized by the absence of GAN or severe stenosis and the presence of IVUS-derived calcification in culprit lesions, which was unmasked in this population. The present findings may give an insight into mechanisms in ACS, screening and medication, as well as recognition of KD in adulthood.

Causes of Acute Coronary Syndrome in Young Adults

Acute coronary syndrome is a major cause of morbidity and mortality worldwide. Although acute coronary syndrome is usually the disease of people over 45 years old, a number of younger patients are also diagnosed with acute coronary syndrome. Besides atherosclerosis, non-atherosclerotic causes of acute coronary syndrome should also be considered during diagnosis. In this paper, we reviewed all causes of the acute coronary syndrome in the young adults.

Acute coronary syndrome in young adults

Acute coronary syndrome in young adults

Clinical Characteristics, Short- and Long-term Outcome of Acute Coronary Syndrome in Young Adults

Recently, prevalence of acute coronary syndrome (ACS) is increasing rapidly, which is an important issue to be resolved. In this study, we investigated the clinical characteristics, short- and long-term outcome of ACS in young adults.

Long-term outcomes of acute coronary syndrome in young adults: Findings from Gulf RACE-2

Long term outcome of young patients presenting with acute coronary syndrome (ACS) has not been described in the Middle East. To evaluate the risk factors, presentations, clinical assessments and long term outcome of young patients as compared with older patients with acute coronary syndrome. The multi-center, prospective Arabian Gulf Registry of Acute Coronary Events (Gulf RACE-2) was used to determine the long term outcome of young patients with ACS. Sixty-five hospitals in 6 Arabian Gulf countries enrolled 7930 ACS patients from October 2008 to June 2009. Patients were divided in to two groups. Group A ⩽40 years, 686 pts (8.7%) with mean age of 36 ± 4 years and Group B >40 years, 7244 pts (91.3%). Group A had a higher prevalence of STEMI (62% vs. 42.9%; P < 0.001), male gender (91.3% vs. 77.6%; P < 0.001), smoking (61.5% vs. 33.2%; P < 0.001) and a lower prevalence of diabetes (18% vs. 42.2%; P < 0.001), hypertension (21.4% vs. 50.2%; P < 0.001) and hyperlipidemia (22% vs. 38.9%; P < 0.001) as compared to Group B. However, in-hospital, 30 days and 1-year mortality rate were significantly lower in Group A compared with Group B (1.9% vs. 4.8%, 4.4% vs. 8.5% and 5.7% vs. 13.2%, respectively; P < 0.001 for all comparisons). ACS among young adults is a major concern. There is a need for prevention programs to control smoking epidemic by targeting young adults in the population. Our study documented for the first time long term outcome among young patients with ACS in the Middle East.

Long-term outcomes of acute coronary syndrome in young adults: findings from GULF RACE-2

Background Long term outcome of young patients presenting with acute coronary syndrome (ACS) has not been described in the Middle East. Objectives To evaluate the risk factors, presentations, clinical assessments and long term outcome of young patients as compared with older patients with acute coronary syndrome. Methods The multi-center, prospective Arabian Gulf Registry of Acute Coronary Events (Gulf RACE-2) was used to determine the long term outcome of young patients with ACS. Results Sixty-five hospitals in 6 Arabian Gulf countries enrolled 7930 ACS patients from October 2008 to June 2009. Patients were divided in to two groups. Group A ⩽40 years, 686 pts (8.7%) with mean age of 36 ± 4 years and Group B >40 years, 7244 pts (91.3%). Group A had a higher prevalence of STEMI (62% vs. 42.9%; P P P P P P P Conclusion ACS among young adults is a major concern. There is a need for prevention programs to control smoking epidemic by targeting young adults in the population. Our study documented for the first time long term outcome among young patients with ACS in the Middle East.

Acute coronary syndrome in young adults from Oman: Results from the gulf registry of acute coronary events

Objective:To assess the prevalence, risk factors, presenting features, and in-hospital outcomes of acute coronary syndrome (ACS) patients ≤40 years of age from Oman.Methods:Data were analyzed from 1579 consecutive ACS patients from Oman during May, 2006 to June, 2007, as part of Gulf RACE (Registry of Acute Coronary Events). ACS patients ≤40 years of age were compared with patients >40 years of age.Results:A total of 121 (7.6%) patients were ≤40 years of age with mean age of 36 ± 4 vs. 61 ± 11 years in young and old adults, respectively (P<0.001). More men were seen in the younger age group (81 vs. 60%; P<0.001). Among all the coronary risk factors, young patients had more history of smoking (47 vs. 15%; P<0.001), obesity (72 vs. 58%; P = 0.009), and family history of coronary artery disease (CAD) (16 vs. 7%; P = 0.001). Both groups received aspirin, statins, thrombolytic therapy, and anticoagulants equally; however, younger patients received clopidogrel, glycoprotein IIb/IIIa inhibitors, β-blockers, and in-hospital coronary angiogram more. Younger patients experienced less heart failure (6 vs. 27%; P<0.001) and in-hospital mortality, especially among STEMI patients (0 vs. 10%; P = 0.037).Conclusions:Young ACS patients from Oman have different risk profile. They were treated more aggressively and their outcome was better, which is similar to other populations. However, smoking, along with obesity and family history of CAD were strong risk factors in the young Omani ACS patients. There is a need for prevention programmes to control smoking and obesity epidemic by targeting young adults in the population.

Mild hypercholesterolemia and premature heart disease: do the national criteria underestimate disease risk?

OBJECTIVESTo determine the frequency of hospital admissions for acute coronary syndrome in young adults and to examine the risk factors that predispose to the development of premature heart disease.BACKGROUNDSignificant coronary heart disease (CHD) is considered rare in the young adult. Current guidelines do not recommend treatment of mild cholesterol abnormalities for primary prevention of CHD in the young.METHODSThis is a large case series of 449 adults (≤50 years) admitted to the hospital with acute coronary syndrome. A history of cardiovascular risk factors and lipid profile were recorded. The presence and extent of CHD were established.RESULTSMean patient age was 44 ± 6 years. Documented CHD was present in 61% of hospital admissions. Multivariate analysis revealed that history of hypercholesterolemia, history of smoking and diabetes were independently associated with premature CHD. The fasting lipid profiles were only borderline to mildly abnormal. Serum total cholesterol, low-density lipoprotein (LDL) and triglyceride levels were not different in cases compared with control subjects. Nearly half (49%) of those with LDL levels of ≥160 mg/dl had only one additional risk factor or none. Despite this, a history of hypercholesterolemia had independent and incremental value on other risk factors for the likelihood of premature CHD.CONCLUSIONSThe magnitude of hospital admissions relating to premature CHD is high. In this population, the presence of borderline or mild hypercholesterolemia has significant effects on the development of premature CHD. These observations have significant implications in the development of guidelines for primary prevention of premature CHD.

Acute coronary syndrome in young adults from a Malaysian tertiary care centre.

Background and Objective:Acute coronary syndrome (ACS) is one of the leading cause of morbidity and mortality worldwide. It is relatively uncommon in young adults as compared to the older population. Our objective was to assess the prevalence, demographic distribution, and risk factors for acute coronary syndrome (ACS) in patients less than 45 years of age admitted to a Malaysian tertiary care centre.Methods:This is a cross-sectional, retrospective, and single centre study with random sampling of the patients admitted for ACS to hospital from January 2005 to December 2013. Data were collected and analyzed. Patients less than 45 years of age were compared with patients more than 45 years of age.Result:A total of 628 patients were included in the study and with the prevalence of young ACS was 6.1% and mean age of 39±6 years. All the young ACS patients were diagnosed with unstable angina and non-ST elevation myocardial infarction (NSTEMI). Tobacco smoking and family history of coronary artery disease (CAD) were more frequent in young ACS. 59.5% of the young ACS patients were smokers, while 37.8% and 51.4% of them were found to suffer from diabetes mellitus and hypertension respectively. Tobacco smoking, diabetes mellitus, and hypertension had shown significant association with the onset of young ACS (p ≤ 0.05).Conclusion:Three leading risk factors (tobacco smoking, diabetes mellitus, and hypertension) had been shown to be significantly associated with the onset of young ACS. Thus, it is important to identify this cohort and implement aggressive measures in tackling the risk factors in order to prevent or halt the development of coronary artery disease.