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. 2020 May 1;59(9):1125-1131.
doi: 10.2169/internalmedicine.4138-19. Epub 2020 Feb 12.

Epidemiological Features and Clinical Presentations of Acute Coronary Syndrome in Young Patients

Hiroaki Sawada  1 , Hirohiko Ando  1 , Hiroaki Takashima  1 , Katsuhisa Waseda  1 , Masahiro Shimoda  1 , Hirofumi Ohashi  1 , Akihiro Suzuki  1 , Shinichiro Sakurai  1 , Yusuke Nakano  1 , Tetsuya Amano  1
Affiliations

Epidemiological Features and Clinical Presentations of Acute Coronary Syndrome in Young Patients

Hiroaki Sawada et al. Intern Med. .

Abstract

Objective Although acute coronary syndrome (ACS) is an uncommon entity in young patients, it constitutes an important problem due to the devastating effects of the disease on the more active lifestyle of young patients. At present, there are no guidelines regarding the prevention of ACS in young patients. Methods We performed a retrospective study of ACS patients between 2014 and 2017. Epidemiological data, clinical findings, and short-term outcomes were evaluated between young ACS patients (≤50 years old) and elderly ACS patients (>50 years old). Results Of a total of 361 consecutive ACS patients, 37 were young ACS patients (10.2%). Compared with elderly ACS patients, young ACS patients showed a higher prevalence of males (94.6% vs. 73.8%, p<0.001), current smoking (70.3% vs. 29.9%; p<0.001), and overweight persons (67.6% vs. 27.8%, p<0.001). The eicosapentaenoic acid (EPA)/arachidonic acid (AA) ratio was significantly lower in young ACS patients than in elderly ACS patients [0.17 (0.12-0.25) vs. 0.25 (0.18-0.37), p=0.002]. The prevalence of cardio-pulmonary arrest and percutaneous cardiopulmonary support use was higher in young ACS patients than in elderly ACS patients (24.3% vs. 8.6%, p=0.003, 16.2% vs. 3.1%, p<0.001). Conclusion The features were markedly different between young ACS patients and elderly ACS patients. In young ACS patients, smoking, being overweight, and a low EPA/AA ratio were distinctive risk factors, and more serious clinical presentations were observed at the onset of ACS than in older patients.

Keywords: EPA/AA; acute coronary syndrome; cardiac arrest; smoking; young patients.

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Conflict of interest statement

The authors state that they have no Conflict of Interest (COI).

Figures

Figure 1.
Figure 1.
Distinctive risk factors associated with ACS in young patients. (A) Prevalence of current smoking between young ACS patients and elderly ACS patients. (B) Prevalence of overweight between young ACS patients and elderly ACS patients. (C) Prevalence of EPA/AA ≤0.3 between young ACS patients and elderly ACS patients. ACS: acute coronary syndrome, EPA: eicosapentaenoic acid, AA: arachidonic acid
Figure 2.
Figure 2.
Prevalence of CPA on arrival and PCPS use. (A) Prevalence of CPA on arrival between young ACS patients and elderly ACS patients. (B) Prevalence of PCPS use between young ACS patients and elderly ACS patients. CPA: cardio-pulmonary arrest, PCPS: percutaneous cardiopulmonary support, ACS: acute coronary syndrome
Figure 3.
Figure 3.
Prevalence of cumulative three risk factors (current smoking, overweight and EPA/AA ≤0.3). The prevalence of three cumulative risk factors (current smoking, overweight and EPA/AA ≤0.3) in both young ACS patients and elderly ACS patients is shown. Patients with two or more risk factors accounted for 90.3% of young ACS patients and 36.4% of elderly ACS patients. Conversely, patients with no risk factors accounted for only 3.2% of young ACS patients. ACS: acute coronary syndrome, EPA: eicosapentaenoic acid, AA: arachidonic acid
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