title: Clinical features of precocious acute coronary syndrome.
abstract: BACKGROUND
  Acute coronary syndrome due to acute plaque rupture has been well described and is associated with established risk factors, including hypertension, diabetes mellitus, hyperlipidemia, and smoking. The prevalence of these risk factors in very young patients (aged ≤35 years) is not well known, and they may have other nontraditional risk factors. We hypothesized that acute coronary syndrome in very young patients may represent a thrombotic event independent of underlying atherosclerotic disease.
  
  
  METHODS
  We performed a dual-institution, retrospective study of consecutive patients aged ≤35 years who presented with acute coronary syndrome and underwent coronary angiography from January 2000 to December 2011. Standard demographics, risk factors, and detailed angiographic information were obtained.
  
  
  RESULTS
  A total of 124 patients met inclusion criteria. The mean age was 31 ± 4 years for both sexes. Approximately half (49%) of the patients were obese (body mass index ≥30 kg/m(2)); 90% of patients had at least 1 traditional risk factor, most commonly hyperlipidemia (63%) and smoking (60%); 52% of patients underwent re-vascularization, of which 94% were by percutaneous coronary intervention, and 42.9% of patients had intracoronary thrombus, of whom approximately one third had no detectable underlying coronary disease.
  
  
  CONCLUSIONS
  Very young patients with acute coronary syndrome tend to be obese, with a high prevalence of smoking and hyperlipidemia. The presence of thrombus in the absence of underlying coronary disease suggests a thromboembolic event or de novo thrombotic occlusion, which may reflect primary hemostatic dysfunction in a considerable number of these patients.
authors: Northwestern University Feinberg School of Medicine, Chicago, Ill. Electronic address: l-davidson@northwestern.edu.
authors: Laura
authors: L
authors: Davidson
authors: Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors: Jane
authors: J
authors: Wilcox
authors: Vanderbilt University Medical Center, Nashville, Tenn.
authors: David
authors: D
authors: Kim
authors: Vanderbilt University Medical Center, Nashville, Tenn.
authors: Stewart
authors: S
authors: Benton
authors: Vanderbilt University Medical Center, Nashville, Tenn.
authors: Joseph
authors: J
authors: Fredi
authors: Northwestern University Feinberg School of Medicine, Chicago, Ill.
authors: Douglas
authors: D
authors: Vaughan
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D000328:Adult; D017023:Coronary Angiography; D003328:Coronary Thrombosis / Q000150:complications*; D005260:Female; D006801:Humans; D006949:Hyperlipidemias / Q000150:complications; D008297:Male; D009204:Myocardial Revascularization; D009765:Obesity / Q000150:complications; D012189:Retrospective Studies; D012307:Risk Factors; D012907:Smoking / Q000009:adverse effects
keywords: Acute coronary syndrome; Hypercoagulability; Thrombosis