Clinical Features of Precocious Acute Coronary Syndrome

• Published in: The American journal of medicine Vol. 127; no. 2; pp. 140 - 144
• Main Authors: Davidson, Laura, MD, Wilcox, Jane, MD, Kim, David, MD, Benton, Stewart, MD, Fredi, Joseph, MD, Vaughan, Douglas, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.02.2014; Elsevier Sequoia S.A
• Subjects: Acute coronary syndrome; Acute Coronary Syndrome - diagnostic imaging; Acute Coronary Syndrome - etiology; Acute Coronary Syndrome - therapy; Acute coronary syndromes; Adult; Coronary Angiography; Coronary Thrombosis - complications; Female; Humans; Hypercoagulability; Hyperlipidemias - complications; Internal Medicine; Male; Myocardial Revascularization; Obesity; Obesity - complications; Retrospective Studies; Risk Factors; Smoking - adverse effects; Thrombosis; Young adults; Hypercoagulability; Acute coronary syndrome; Thrombosis
• ISSN: 0002-9343; 1555-7162
• DOI: 10.1016/j.amjmed.2013.09.025

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/m2 ); 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.