Long-Term Outcome of Acute Coronary Syndromes in Young Patients.
BACKGROUND
Acute coronary syndromes (ACS) in young patients are uncommon and their influence on morbidity and mortality in this population is still debated.


OBJECTIVE
We investigated clinical and angiographic characteristics, risk factors and outcome in young patients diagnosed with ACS, compared with those of older patients, evaluating survival free from death and/or nonfatal myocardial infarction (MI) and/or coronary revascularization (primary endpoint), and then with respect to each component of the primary endpoint.


METHODS
We retrospectively analyzed 1696 patients diagnosed with ACS between 2007 and 2013. 116 were aged ≤45 years (young adults), 1116 were >45 and <75 years (older adults) and 464 were ≥75 years.


RESULTS
Young adults were mostly male, with a prevalent diagnosis of STEMI, had less frequently typical cardiovascular risk factors and lower prevalence of extensive coronary artery disease. Over a median 3 years follow up, survival free from composite endpoint was better in young than in older adult patients (11.2 vs. 24.2%; p = 0.001), mainly due to a lower rate of death while the occurrence of non fatal MI and of coronary revascularization was similar (7.8 vs. 8.7%, p = 0.86; 8.7 vs. 12.9%, p = 0.23 respectively). Diabetes was the strongest independent risk factor of worse prognosis in the young cohort (OR 3.47; 95% CI 1.01-11.9; p = 0.04).


CONCLUSIONS
Young adults showed peculiar clinical features and lower mortality compared with older adults. Morbidity was not different between the two populations, with diabetes independently associated with a worse prognosis.
Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Ospedale Sant'Andrea, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Giacomo
G
Tini
Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Ospedale Sant'Andrea, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Giulia
G
Proietti
Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Ospedale Sant'Andrea, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Matteo
M
Casenghi
Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Ospedale Sant'Andrea, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Marzia
M
Colopi
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy.
Katia
K
Bontempi
Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Ospedale Sant'Andrea, Via di Grottarossa 1035-1039, 00189, Rome, Italy.
Camillo
C
Autore
Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Ospedale Sant'Andrea, Via di Grottarossa 1035-1039, 00189, Rome, Italy.|IRCCS Neuromed, Pozzilli, IS, Italy.
Massimo
M
Volpe
Cardiology, Department of Clinical and Molecular Medicine, Faculty of Medicine and Psychology, Sapienza University of Rome, Ospedale Sant'Andrea, Via di Grottarossa 1035-1039, 00189, Rome, Italy. beatrice.musumeci@uniroma1.it.
Beatrice
B
Musumeci
D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D000328:Adult; D017668:Age of Onset; D000368:Aged; D016009:Chi-Square Distribution; D015897:Comorbidity; D017023:Coronary Angiography; D003920:Diabetes Mellitus / Q000453:epidemiology; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization; D016017:Odds Ratio; D015995:Prevalence; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy; D013997:Time Factors; D016896:Treatment Outcome
Acute coronary syndromes; Diabetes; Myocardial infarction; Outcome; Young