Acute coronary syndrome in very young adults (<35 years of age) - time to awake and act! A prospective analytical study from South India

Background: Acute coronary syndrome in very young adults (<35 yrs) was considered as an uncommon entity, recently shows rising incidence especially in India. Hence we planned this study with the aim, to investigate the incidence, clinical, angiographic profile and outcome of ACS in this population. Methods: This is a prospective analytical study included patient <35 yrs with ACS admitted to cardiology department in a tertiary hospital of South India. Risk factors, clinical, angiographic profile and follow up data were recorded and analyzed. Results: Among the total 2180 patients with ACS, 5.8% (n=127) were very young adults. Youngest one was 11 yrs old with coronary anomaly. Median age was 30yrs (SD±3) and only 8.6% (n=10) were obese. Smoking, male sex were the major conventional risk factors followed by low HDL (52%). Family history of premature coronary event seen in 12.9%, hyperhomocysteinemia, elevated LPA and high fibrinogen were observed in 15%, 20% and 3.5% respectively. Anterior wall MI with LAD occlusion was the commonest type (66.3%). Angiographically 31.4% (36/116) had recanalised vessels, coronary anomaly was seen in 3 (2.5%) patients and pure ectasia in 4 (3.4%) patients. Only 2 were undergone primary PCI (1.7%), 61% (n=71) received thrombolytic therapy. Median delay for angiogram was 72 hrs (3 days). In-hospital mortality was 3.4% and 4.5% (n=5) during follow up. Conclusions: The incidence of ACS among very young adults is on the rising trend (5.8%). Obstructive CAD in 56.9% patients implies the rapid progression of atherosclerosis. With little contribution of novel risk markers of atherosclerosis, smoking and dyslipidemia accelerate the process of premature vascular aging in Indian subcontinent.