STUDY OF RISK FACTORS, CLINICAL, LABORATORY, CORONARY LESION CHARACTERISTICS OF ACUTE CORONARY SYNDROME IN PATIENTS UNDER 40 YEARS OLD
Authors: Huynh Van Minh , Ho Anh Binh , Dinh The Anh 
Published: May 2021

Background: There is little data regarding the characteristics of young (< 40 years old) Vienamese who get acute coronary syndrome patients. The aim of this study was to compare some risk factors, clinical, laboratory, coronary lesion characteristics and predicting mortality according to the GRACE and TIMI scores of young acute coronary syndrome (CAD) patients compared with their older counterparts.

Materials and method: The cross – sectional descriptive study of 69 patients with acute coronary syndrome at the Interventional Cardiovascular Center of Hue Central Hospital and Hue University of Medicine and Pharmacy Hospital from May 2017 to December 2018. These patients were divided into two groups: 33 patients were aged < 40 years (group 1) and 36 patients were aged ≥ 40 years (group 2). Demographic characteristics, risk factors profile, clinical, laboratory, coronary lesion findings and predicting mortality were compared between the two groups.

Results: Compared with group 2, the prevalence of male gender, smoking, family history of CAD were higher in group 1 and the prevalence of arterial hypertension, diabetes mellitus were lower (84.8%; 57.6%; 18.2% and 30.3%; 3.0% of group 1 vs 55.6%; 33.3%; 2.8% and 69.4%; 22.2% of group 2, respectively; p < 0.05). Group 1 had more severe angina (the prevalence of chest pain graded III-IV by CCS classification were 69,7% in group 1 vs 36.1% in group 2; p < 0.05) and lower systolic pressure (median was 120 mmHg in group 1 vs 135 mmHg in group 2; p < 0.05). The prevalence of unstable angina and STEMI were higher in group 1 (51.5% and 36.4% in group 1 vs 30.6% and 11.1% in group 2, respectively; p < 0.05), while NSTEMI was higher in group 2 (58.3% in group 2 vs 12.1% in group 1; p < 0.05). Group 1 had lower serum Glucose level but higher serum Creatinine level than group 2 (medians were 5.3 mmol/l and 80 µmol/l in group 1 vs 6.44 mmol/l and 72.5 µmol/l in group 2, respectively; p < 0.05). The prevalence of single vessel disease, angiographically normal coronary arteries, nonobstructive disease in group 1 were also higher and multi-vessel disease was lower than group 2 (45.5%; 33.3%; 12.1% and 9.1% in group 1 vs 33.3%; 2.8%; 2.8% and 61.2% in group 2; p < 0.05). The Gensini, GRACE and TIMI scores were lower in group 1 (median was 5; medium was 78.55 and median was 2 in group 1 vs 37.5; 130.22 and 3 in group 2, respectively; p < 0.05). Smoking was a risk factor for obstructed CAD in group 1 (OR = 7.12; 95% CI: 1.25 - 40.63; p < 0.05).

Conclusion: Young patients with acute coronary syndrome tend to be male, smoking and positive familial history; grade of angina was more severe and systolic pressure was lower; the prevalence of unstable angina and STEMI were higher. In contrast, older patients had higher serum Glucose level and lower serum Creatinine level; the prevalence of multi-vessel disease was higher. The Gensini, GRACE and TIMI scores were lower in young patients. Smoking was a risk factor for obstructed CAD in young patients.

Key words: CAD: acute coronary syndrome, 40 years old