Acute Coronary Syndrome in the Young: Clinical Characteristics, Risk Factors and Prognosis

Abstract

Background:To describe the characteristics of patients ≤40 years of age hospitalized for acute coronary syndrome, analyze the risk factors and identify the variables associated with prognosis.Methods:Case series of patients admitted between 2003 and 2012 inclusive in a tertiary hospital (123 consecutive cases admitted between 2003 and 2012), and case-control study (369 controls selected from the general population matched for sex and age with cases, at a ratio of 3:1). Outcome variables: Mortality, likelihood of survival without readmission for heart-related problems, extent of coronary disease as determined by coronary angiography and cardiovascular risk factors. Results: Mean age was 35.4±4.8 years and 83.7% of the participants were men. Myocardial infarction with abnormal Q wave (48%) and single-vessel involvement (44.7%) predominated. Intrahospital mortality was 1.6%. For the 108 patients eventually included in the follow-up, likelihood of readmission-free survival after 60 months was 69.3±4.8%. In the case group 36% of the patients admitted to using cocaine. Compared to controls, the prevalence in patients was higher for smoking (74.8 vs 33.1%, p<0001), diabetes (14.6% vs 5.1%, p=0.001), low HDL-cholesterol (82.9 vs 34.1%, p<0.001) and obesity (30.0 vs 20.3%, p=0.029). Decreased left ventricular ejection fraction (odds ratio=2.2, p=0.033) and smoking (odds ratio=7.8, p=0.045) were associated with readmission for coronary syndrome.Conclusion: Acute coronary syndrome in people younger than 40 years is associated with diabetes and unhealthy lifestyle: smoking, sedentary behavior (low HDL-cholesterol), cocaine use and obesity. The readmission rate is high, and readmission is associated with smoking and decreased ejection fraction.

Risk factors, prognosis, and secondary prevention of myocardial infarction in young adults in Poland

“…Andrés et al [22] reported an even greater disproportion between young (< 46 years) and older patients: 2.77% vs. 13.65%, respectively. At the same time, there is a great risk of cardiovascular rehospitalisation, especially if the patient continues to smoke [32]. The results of studies by Nielsen et al [33] should therefore come as no surprise, wherein long-term mortality in young patients after MI, albeit low, remains two to four times higher than in the general male population, and even higher in women.…”

Behaviour of the neutrophil to lymphocyte ratio in young subjects with acute myocardial infarction

“…In the last years many papers have regarded the acute coronary syndromes [18,42] and the myocardial infarction in young patients [6,21] although in these reports the age considered has been respectively of 35 years [42], of 40 years [6,18], and between 30 and 54 years [21].…”

Brátt hjartadrep á Íslandi í fertugum og yngri 2005-2009

“…7 Það er því tímabaert að kanna á ný stöðu mála í yngsta sjúklingahópnum sem í fyrri rannsókninni reyndist hafa margs konar sérstöðu miðað við aðra aldurshópa 6 en þó áþekka því sem lýst hefur verið í mörgum erlendum rannsóknum. [3][4][5][8][9][10][11][12][13][14] Markmið þessarar rannsóknar var því að kanna hver þróunin hefur orðið meðal ungra þolenda alvarlegs kransaeðasjúkdóms og áherslan, eins og í fyrri rannsókninni, á nýgengi, áhaettuþaetti og afdrif, sem og á útbreiðslu kransaeðaþrenginganna.…”

“…9 Í mörgum rannsóknum virðist tilhneiging vera í þá átt að hlutfall kvenna meðal ungra einstaklinga með brátt hjartadrep fari haekkandi.…”

“…19 Sykursýki hefur í erlendum rannsóknum komið fram sem marktaekur sjálfstaeður áhaettuþáttur kransaeðastíflu meðal ungs fólks. 9 Í þessari rannsókn voru aðeins þrír sykursjúkir einstaklingar (einn í fyrri rannsókninni) og þannig of fáir til að unnt sé að meta vaegi sjúkdómsins. Þess ber þó að geta að sykursýki er oft vangreindur sjúkdómur.…”