Acute Coronary Syndrome in the Young: Clinical Characteristics, Risk Factors and Prognosis
Marcos R Esteban 1, Sara M Montero 2, José J. A Sánchez 3, 4, Horacio P Hernández 1, José J. G Pérez 1, Julio H Afonso 1, del C. R Pérez 3, 4, Buenaventura B Díaz 3, 4, Antonio C de León*, 3, 4, 5
1 Servicio de Cardiología
2 Unidad de Medicina Intensiva, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
3 Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, Spain
4 Red de Investigación Cardiovascular, Instituto de Salud Carlos III, Madrid, Spain
5 Área de Medicina Preventiva y Salud Pública, Universidad de La Laguna, La Laguna, Spain
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.
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.
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.
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.
Keywords: Acute coronary syndrome, prognosis, risk factors, young age..
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* Address correspondence to this author at the Unidad de Investigación de Atención Primaria y del Hospital Universitario Nuestra Señora de Candelaria, Carretera de El Rosario 145, 38010 Santa Cruz de Tenerife, Canary Islands, Spain; Tel: +34 922 600602; Fax: +34 922 600562;