Iranian Heart Journal

Iranian Heart Journal

Age-Connected Variations of Clinical and Angiographic Profiles and Outcomes in an Urban Population With Acute Coronary Syndrome

Document Type : Original Article

Authors
Kamran Ahmed Khan 1
Rajesh Kumar 1
Jehangir Ali Shah 1
Muhammad Naeem Mengal 1
Fawad Farooq 1
Rizwan Khan 2
Ashok Kumar 3
Jawaid Akbar Sial 1
Tahir Saghir 1
Abdul Samad Achakzai 1
Musa Karim 1
1 National Institute of Cardiovascular Diseases (NICVD), Karachi, Pakistan.
2 National Institute of Cardiovascular Diseases (NICVD), Sehwan, Pakistan.
3 National Institute of Cardiovascular Diseases (NICVD), Hyderabad, Pakistan.
Abstract
Background: Acute coronary syndrome (ACS) is a rapidly growing concern, especially among younger urban communities. We aimed to study age-based differences in clinical and angiographic profiles and outcomes in an urban population.
Methods: This study recruited 2 independent, equal-sized cohorts of consecutive patients with ACS undergoing coronary angiography: younger and older cohorts (based on an age cutoff point of 35 years). Clinical and angiographic profiles were compared as primary endpoints, and in-hospital and 3-month major adverse cardiovascular events (MACE) were compared between the 2 cohorts as secondary endpoints.
Results: Each cohort was composed of 103 patients. The younger cohort, compared with the older cohort, revealed higher overweight (69.9% vs 51.5%), positive family history (12.6% vs 4.9%; P=0.048),  use of gutka (smokeless tobacco) (56.3% vs 14.3%; P=0.017), smoking (41.7% vs 33%; P=0.195), total cholesterol (155.05±46.6 mg/dL vs 140.40±35.6 mg/dL; P=0.012), low-density lipoprotein cholesterol (96.74±41.23 mg/dL vs 84.14±27.25 mg/dL; P=0.010), normal/nonobstructive coronaries (15.5% vs 1.9%; P<0.001), single-vessel disease (60.2% vs 35.0%), type A lesions (36.8% vs 17.8%), left ventricular ejection fraction exceeding 40% (57.3% vs 42.7%; P=0.037), medical treatment only as the management strategy (16.5% vs 2.9%), in-hospital MACE (8.7% vs 12.6%; P=0.0367), and 3-month MACE (4.9% vs 12.6%; P=0.048), respectively.
Conclusions: Our younger subjects tended to have higher weight, gutka use, and positive family history than traditional risk factors with a greater frequency of single-vessel disease with type A lesions and normal or nonobstructive disease amenable to medical treatment only. (Iranian Heart Journal 2022; 23(2): 96-105)
Keywords
ACS
CAD
Urban population
Young
Age-related differences
  1. Braunwald E, Morrow DA. Unstable angina: is it time for a requiem? Circulation 2013; 127(24):2452-7.
  2. Puricel S, Lehner C, Oberhänsli M, Rutz T, Togni M, Stadelmann M, et al. Acute coronary syndrome in patients younger than 30 years–aetiologies, baseline characteristics and long-term clinical outcome. Swiss Medical Weekly 2013; 143:w13816.
  3. Gotsman I, Lotan C, Mosseri M. Clinical manifestations and outcome of acute myocardial infarction in very young patients. Isr Med Assoc J 2003; 5:633-6.
  4. Khan KA, Khan MN, Kumar R, Shah JA, Batra MK, Kumar D, et al. A surge in prevalence and factors affecting early onset acute coronary syndrome. Signa Vitae 2021; 1:8. doi:10.22514/sv.2021.138
  5. Tungsubutra W, Tresukosol D, Buddhari W, Boonsom W, Sanguanwang S, Srichaiveth B. Acute coronary syndrome in young adults: the Thai ACS Registry. J Med Assoc Thai 2007; 90(Suppl 1):81-90.
  6. Doughty M, Mehta R, Bruckman D, Das S, Karavite D, Tsai T, et al. Acute myocardial infarction in the young - the University of Michigan experience. Am Heart J 2002; 143:56-62.
  7. Zimmerman FH, Cameron A, Fisher LD, Ng G. Myocardial infarction in young adults: angiographic characterization, risk factors and prognosis (Coronary Artery Surgery Study Registry). J Am Coll Cardiol 1995; 26:654-61.
  8. Chaithiraphan S, Sahasakul Y, Charoenchob N. Acute myocardial infarction in the young. J Med Assoc Thai 1985; 68:190-7.
  9. Avezum A, Makdisse M, Spencer F, Gore JM, Fox KA, Montalescot G, et al. Impact of age on management and outcome of acute coronary syndrome: observations from the Global Registry of Acute Coronary Events (GRACE). Am Heart J 2005; 149:67-73.
  10. Hong MK, Cho SY, Hong BK, Chang KJ, Chung IM, Lee MH, et al. Acute myocardial infarction in the young adults. Yonsei Med J 1994; 35:184-9.
  11. Thygesen K, Alpert JS, Jaffe AS, Chaitman BR, Bax JJ, Morrow DA, et al. Fourth universal definition of myocardial infarction (2018). J Am Coll Cardiol 2018; 72(18):2231-64.
  12. Batra MK, Rizvi NH, Sial JA, Saghir T, Karim M. Angiographic Characteristics and in Hospital Outcome of Young Patients, Age Up to 40 Versus More Than 40 Years Undergoing Primary Percutaneous Coronary Intervention. J Pak Med Assoc 2019; 69(9):1308-12.
  13. Alhejily WA, Ohman EM. Repeat revascularization after PCI: are we reinventing the wheel or redefining Achilles' heel? Cir Cardiovasc Interv 2012;5(6):746-7.
  14. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Drazner MH, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2013; 62(16):e147-239.
  15. Schoenenberger AW, Radovanovic D, Stauffer JC, Windecker S, Urban P, Niedermaier G, et al. Acute coronary syndromes in young patients: presentation, treatment and outcome. Int J Cardiol 2011; 148(3):300-4.
  16. Michos ED, Choi AD. Coronary Artery Disease in Young Adults: A Hard Lesson But a Good Teacher. J Am Coll Cardiol 2019; 74(15):1879-82.
  17. Gestro M, Condemi V, Bardi L, Tomaino L, Roveda E, Bruschetta A, et al. Short-term air pollution exposure is a risk factor for acute coronary syndromes in an urban area with low annual pollution rates: Results from a retrospective observational study (2011–2015). Arch Cardiovasc Dis. 2020; 113(5):308-20.
  18. Colkesen AY, Acil T, Demircan S, Sezgin AT, Muderrisoglu H. Coronary lesion type, location, and characteristics of acute ST elevation myocardial infarction in young adults under 35 years of age. Coron Artery Dis 2008; 19(5):345-7.
  19. Maroszyńska-Dmoch EM, Wożakowska-Kapłon B. Clinical and angiographic characteristics of coronary artery disease in young adults: a single centre study. Kardiol Pol 2016; 74(4):314-21.
  20. Reuter PG, Pradeau C, Huo Yung Kai S, Lhermusier T, Bourdé A, Tentillier E, et al. Predicting acute coronary syndrome in males and females with chest pain who call an emergency medical communication centre. Scand J Trauma Resusc Emerg Med 2019; 27(1):92.
  21. Khan KA, Batra MK, Kumar D, Ali S, Kumar V, Kumar R, et al. Territorial impact on clinical outcomes in young population with ST-segment elevation myocardial infarction. Pak Heart J 2021; 54(1):97-106.
  22. Obaya M, Yehia M, Hamed L, Fattah AA. Comparative study between elderly and younger patients with acute coronary syndrome. Egypt J Crit Care Med 2015; 3(2-3):69-75.
  23. Lv S, Liu W, Zhou Y, Liu Y, Shi D, Zhao Y, et al. Hyperuricemia and severity of coronary artery disease: An observational study in adults 35 years of age and younger with acute coronary syndrome. Cardiol J 2019; 26(3):275-82.
  24. Pour HA, Norouzzadeh R, Heidari MR. Comparison of clinical presentation related on risk factors in older and younger patients with acute coronary syndrome. Int J Clin Cardiol 2015; 2:058.
  25. Adam AM, Rehan A, Waseem N, Iqbal U, Saleem H, Ali MA, et al. Prevalence of conventional risk factors and evaluation of baseline indices among young and elderly patients with coronary artery disease. Journal of clinical and diagnostic research: JCDR 2017; 11(7):OC34.
  26. Alberty R, Studenčan M, Kovář F. Prevalence of conventional cardiovascular risk factors in patients with acute coronary syndromes in Slovakia. Cent Eur J Public Health 2017; 25(1):77-84.
  27. Prajapati J, Jain S, Virpariya K, Rawal J, Joshi H, Sharma K, et al. Novel atherosclerotic risk factors and angiographic profile of young Gujarati patients with acute coronary syndrome. J Assoc Physicians India 2014; 62(7):584-8.
  28. Haque AF, Siddiqui AR, Rahman SM, Iqbal SA, Fatema NN, Khan Z. Acute coronary syndrome in the young-risk factors and angiographic pattern. Cardiovasc J 2010; 2(2):175-8.
  29. Anjum M, Zaman M, Ullah F. Are Their Young Coronaries Old Enough? Angiographic Findings In Young Patients With Acute Myocardial Infarction. J Ayub Med Coll Abbottabad 2019; 31(2):151-5.
Iranian Heart Journal
Volume 23, Issue 2
Spring 2022
Pages 96-105