Acute coronary syndrome in young adults.
BACKGROUND
The aim of this study was to assess the features of acute coronary syndrome (ACS) in patients younger than 46 years of age.


METHODS
This was a retrospective study of clinical features, complications and diagnostic and therapeutic strategies of patients hospitalized between 1999 and 2007 with a diagnosis of ACS in a non-tertiary hospital. Data were collected from clinical records.


RESULTS
The study population included 128 patients. The male/female ratio was 94%/6% and mean age was 40 +/- 3.9 years. The distribution of ACS was as follows: ST-elevation acute myocardial infarction (AMI) 69%, non-ST elevation AMI 20%, unstable angina 9%, AMI with undetermined ECG 1%, and Prinzmetal angina 1%. The prevalence of cardiovascular risk factors was as follows: smoking 82.8%, dyslipidemia 42.2%, hypertension 28.9%, and diabetes 4.7%. Thrombolysis was the main myocardial reperfusion therapy, used in 76.1%. Echocardiography during hospitalization revealed normal left ventricular (LV) function in 66.1%, mild LV dysfunction in 14.5%, moderate LV dysfunction in 10.5% and severe LV dysfunction in 8.9%. Predischarge exercise testing was performed in 64.1% of patients and was normal in 85.4%, abnormal in 13.4% and inconclusive in 1.2%. Only 3.9% underwent single photon emission computed tomography (SPECT) myocardial perfusion imaging, which was positive for ischemia in 60% and negative in 40%. Elective catheterization was performed in 22.7% of patients; 44.9% underwent percutaneous coronary intervention and 6.9% were referred for cardiac surgery. Medication prescribed at discharge was as follows: aspirin 97.7%, beta-blockers 90.6%, statins 84.4%, angiotensin-converting enzyme inhibitors 50% and clopidogrel 25%. Arrhythmias were the main complication of ACS and no deaths occurred during hospitalization.


CONCLUSIONS
As expected, ACS in young adults had a higher incidence in males. ST-elevation AMI was the main type. Most patients were smokers. Thrombolysis was the main myocardial reperfusion therapy. Echocardiography and predischarge exercise testing were the main complementary diagnostic tests for risk stratification. Prescription rates of drugs that improve prognosis were high.
Serviço de Cardiologia do Hospital de São Sebastião, Santa Maria da Feira, Portugal. mario_mteixeira@yahoo.com
Mário
M
Teixeira
Isabel
I
Sá
J Santos
JS
Mendes
Luís
L
Martins
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000628:therapy; D000328:Adult; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies