PRESENTATION, MANAGEMENT, AND EARLY OUTCOMES OF YOUNG ACUTE CORONARY SYNDROME PATIENTS- ANALYSIS OF 23,560 SOUTH ASIAN PATIENTS FROM 2012-2021

Abstract

Therapeutic Area: ASCVD/CVD Risk Factors Background: There is a scarcity of literature exploring early outcomes of young acute-coronary-syndrome patients, predominantly in South Asians, who are considered to be at most risk of developing premature coronary artery disease. Therefore, we compared presentation, management, and early outcomes of young vs. old ACS patients and explored predictors of in-hospital mortality. Methods: We extracted data of 23,560 ACS patients presented at Tabba Heart Institute, Karachi, Pakistan, from July 2012-June 2020, from the Chest pain-MI Registry™. Young patients: ≤45 years. Chi-sq/Fischer exact tests assessed the difference between variables in younger vs. older patients. Logistic regression was used to determine predictors of early mortality, and odds ratios along with 95% confidence intervals were reported. Results: The mean age was 59.0±11.4 years, women: 23.5%, and younger patients: 12.3%. Dyslipidemia (34.5% vs. 22.4%), diabetes (52.1% vs. 27.4%) and hypertension (68.3% vs. 42.9%) were higher in older adults. In contrast, Family history of premature coronary artery disease (32.7% vs. 18.1%) and smokeless-tobacco (8.4% vs. 6.5%) was higher in young adults. Younger adults were more likely to present with STEMI (45% vs. 33.2%) and be asymptomatic on presentation (40.8% vs. 36.1%). Median symptom-to-door-time was higher in younger patients (760(192, 3140) vs. 635(186,2735) minutes). Coronary angiography and CABG were higher in older patients; however, PCI was higher in young adults. The use of all medications in first 24 hours except IV anticoagulant and angiotensin receptor blockers was higher in younger adults. In-hospital mortality (4.3% vs. 1.7%) and complications including cardiac arrest (1.9% vs. 0.7%), cardiogenic shock (1.9% vs. 0.9%) and heart failure (1% vs. 0.6%) were more common in older patients. After adjusting for risk factors, older age (2.4, 1.5-3.7) was a significant predictor of early mortality. Other predictors included: STEMI (OR:3.2, 95% CI:1.9-5.5), women (1.4, 1,1-1.8), Killip III/IV (3, 2.4-3.8), cardiac arrest (3.2, 2.2-4.5) and heart failure (1.8, 1.4-2.3) at presentation, Left ventricular ejection fraction (0.9, 0.93-0.95) and PCI (1.3, 1.1-1.7) and CABG (3, 2.3-3.9) at index hospitalization. Conclusion: Younger patients presented differently from their older counterparts as they were likely to be asymptomatic and have STEMI. They had favorable clinical outcomes, which might be explained by the aggressive treatment.