Acute coronary syndromes in young patients: presentation, treatment and outcome.
BACKGROUND
Acute coronary syndromes (ACS) in very young patients have been poorly described. We therefore evaluate ACS in patients aged 35 years and younger.


METHODS
In this prospective cohort study, 76 hospitals treating ACS in Switzerland enrolled 28,778 patients with ACS between January 1, 1997, and October 1, 2008. ACS definition included ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina (UA).


RESULTS
195 patients (0.7%) were 35 years old or younger. Compared to patients>35 years, these patients were more likely to present with chest pain (91.6% vs. 83.7%; P=0.003) and less likely to have heart failure (Killip class II to IV in 5.2% vs. 23.0%; P<0.001). STEMI was more prevalent in younger than in older patients (73.1% vs. 58.3%; P<0.001). Smoking, family history of CAD, and/or dyslipidemia were important cardiovascular risk factors in young patients (prevalence 77.2%, 55.0%, and 44.0%). The prevalence of overweight among young patients with ACS was high (57.8%). Cocaine abuse was associated with ACS in some young patients. Compared to older patients, young patients were more likely to receive early percutaneous coronary interventions and had better outcome with fewer major adverse cardiac events.


CONCLUSIONS
Young patients with ACS differed from older patients in that the younger often presented with STEMI, received early aggressive treatment, and had favourable outcomes. Primary prevention of smoking, dyslipidemia and overweight should be more aggressively promoted in adolescence.
Schoenenberger
Andreas W
AW
Department of Geriatrics and General Internal Medicine, University of Berne Hospital Inselspital, Institute of Social and Preventive Medicine, University of Berne, Berne, Switzerland.
Radovanovic
Dragana
D
Stauffer
Jean-Christophe
JC
Windecker
Stephan
S
Urban
Philip
P
Niedermaier
Gregor
G
Keller
Pierre-Frédéric
PF
Gutzwiller
Felix
F
Erne
Paul
P
D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000503:physiopathology / Q000628:therapy*; D000328:Adult; D000367:Age Factors; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D015331:Cohort Studies; D006801:Humans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy; D011446:Prospective Studies; D016896:Treatment Outcome