Premature acute coronary syndrome: understanding the early onset

Abstract

Introduction Acute coronary syndrome (ACS) is less frequent in young adults, but it has become a significant health problem, associated with the increasing prevalence of modifiable risk factors.Objectives To characterize patients admitted with premature ACS, comparing with those with nonpremature ACS. MethodsWe performed a retrospective study encompassing patients of the Portuguese Registry (ProACS), comparing two groups: one composed of men less than 55 and women less than 65 years old; and other with men ≥55 and women ≥65 years old at the ACS admission. The primary endpoint was the composite of in-hospital mortality, stroke and myocardial reinfarction (re-MI).Results A total of 29 870 patients were enrolled and 25% had premature ACS, with a mean age of 50 ± 7 years old. They had a larger prevalence of smoking habits, obesity and dyslipidemia. ST-segment elevation MI (STEMI) was the main admission diagnosis in young patients and coronary angiogram mainly revealed one vessel disease in this subgroup. They had a lower Killip-Kimball (KK) class and mostly preserved left ventricular ejection fraction (LVEF). Composite endpoint was more frequent in nonpremature ACS patients. Nonpremature age, presentation with syncope or cardiac arrest, KK class >1, multivessel disease and LVEF <40% were independent predictors of the primary endpoint (P < 0.001). Younger patients had lower rates of in-hospital all-cause mortality, re-MI and stroke. One-year all-cause mortality and 1-year cardiovascular and non-cardiovascular readmissions were also lower. ConclusionsPremature ACS affects 25% of the ACS population, mostly presenting with STEMI, but generally associated with better clinical evolution. Nevertheless, prevention measures are essential to correct modifiable cardiovascular risk factors and reduce coronary events.

Clinical Characteristics and Outcomes of Chinese Patients with Premature Acute Coronary Syndrome

“…In terms of interventional characteristics, the left anterior descending artery was the most commonly involved vessel, confirming the findings of other studies. 6,24) Furthermore, a comparison of the number of diseased vessels showed that the premature ACS group had a significantly higher incidence of single-vessel lesions and a lower incidence of triple-vessel lesions than the nonpremature ACS group, which is similar to previous findings. 7,10,25) Because patients with nonpremature ACS were older, these results indicated that a high incidence of multivessel lesions may be associated with aging.…”

“…Most patients in our study experienced NSTE-ACS, which was inconsistent with the trends in the majority of published studies. 6,25,27) This indicated that the majority of ACS types in patients in this region of China between July 2009 and August 2011 were NSTE-ACS, constituting a potential bias attributed to the use of singlecenter data. It is known that NSTE-ACS is more associated with multivessel disease, suggesting that patients with NSTE-ACS have worse clinical outcomes, 28 such as greater late mortality and an increased reinfarction risk.…”

“…Several studies have confirmed sex differences between premature and nonpremature ACS patients. Menezes, et al 6) and Shi, et al 10) have reported that the proportion of female individuals was significantly higher among patients with premature ACS than those with nonpremature ACS. Furthermore, Shi, et al that female sex was an independent risk factor for the accelerated development of ACS, indicating that the risk of developing premature ACS in Chinese women gradually increases, which is consistent with our findings.…”

“…Compared with elderly patients, patients with premature ACS have different risk factor profiles, clinical manifestations, and prognoses. 6) Therefore, studying the younger population and identifying risk factors are necessary to better understand the development of premature ACS. Furthermore, early identification of these patients is crucial to prevent adverse cardiovascular events.…”

“…7) At present, most research data on the clinical characteristics and possible risk factors of premature ACS are from Western countries. 6) However, there are differences in the genes, diet structure, and reference standards of laboratory results between Western and Chinese patients. Thus, the current research findings do not fully represent the actual situation of premature ACS patients in China.…”