Analytical study of angiographic profile of acute coronary syndrome and its risk factors among young individuals (≤45 years)

Abstract

Background: Acute coronary syndrome (ACS) in young (≤45 years) patients has devastating social and economic consequences. We present the clinical presentation, coronary angiogram (CAG) findings with particular reference to angiographic severity, treatment, and short-term follow-up. Methods: This was an ambidirectional cohort study (n = 224) conducted in the department of cardiology of a tertiary care teaching hospital in South India, catering mainly to a predominantly rural population. Patients were identified from “The CATH-lab Registry” and the data were analyzed. Results: The mean (±standard deviation) age was 39.02 ± 5.6 years, with a male predominance (79.9%). Dyslipidemia (57.6%), smoking (25.9%), and diabetes mellitus (29.9%) emerged as major risk factors. Almost equal proportion of patients presented with ST-segment elevation myocardial infarction (STEMI; 53.12%) and non-ST elevation ACS (46.88%); 30.8% of patients had left ventricular (LV) dysfunction. CAG showed involvement of left anterior descending artery in the majority (66.38%) of patients with single-vessel disease in the STEMI group. Left main coronary artery involvement was seen in 8.9% of patients. Majority (89.7%) of young ACS patients had low syntax score. Risk factors were similar among patients with obstructive and nonobstructive CAD. Almost half (47.7%) of the patients needed revascularization, with 16.9% undergoing coronary artery bypass graft surgery. Only two patients had recurrent ACS, at a mean follow-up of 12 months. Conclusions: The most important risk factors for young ACS were dyslipidemia, smoking, and diabetes mellitus. LV function was preserved in majority of young ACS patients and short-term prognosis (1 year) was favorable.

Keywords

• angiographic score
• coronary angiogram
• coronary artery disease
• percutaneous coronary intervention
• syntax score