Risk factors and angiographic profile in young patients with naive acute coronary syndrome

Introduction: Despite cardiovascular diseases having grown to epidemic proportions, there are few studies from India pertaining to acute coronary syndrome (ACS), more so from the region of Purvanchal which is less developed. There is also increasing prevalence of coronary artery disease in young patients. Our study is first of its kind in this region of young patients presenting for the first time with ACS.
Aim: The present study was done with the aim of evaluation of clinical and angiographic characteristics of young ACS patients of Purvanchal and compare with that of the elderly.
Methods: This was a prospective cohort study of 180 patients admitted with acute coronary syndrome. Patients were excluded if they had prior cardiac pathology like valvular heart disease, cardiomyopathy, pericardial disease, cor pulmonale, ischaemic heart disease or cardiac revascularisation. Patients who did not undergo angiography were excluded. Patients were divided into two groups of young ACS (age 18-40 years) and older ACS patients (age > 40 years). Clinical characteristics analyzed in each group were age, gender, presence or absence of diabetes mellitus, hypertension, dyslipidaemia, smoking, obesity, family history, duration of chest pain, and treatment received. Angiographic profile were also studied in both groups.
Results: Males were predominant with mean age 57.8 years and 35.6 years respectively in the two groups. Young patients had greater prevalence of smoking whereas hypertension was more prevalent in the elderly group. Family history of CAD, Diabetes and obesity were not significantly different in the two groups. Average serum levels of LDL-C and TG were significantly higher in the young ACS patients as compared to the older ACS patients. Younger patients more commonly presented with STEMI and predominantly had SVD. Significant number of patients in the young ACS group had insignificant stenosis. Multivessel disease was more common in older age patients. Distribution of coronary lesions was not significantly different in the two groups.
Conclusions: Young patients have a different risk factor profile in comparison to older patients. Risk factor identification and control, early presentation and treatment are crucial.