Long-Term Outcome of Acute Coronary Syndromes in Young Patients
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ORIGINAL ARTICLE
Long-Term Outcome of Acute Coronary Syndromes in Young Patients Giacomo Tini1 • Giulia Proietti1 • Matteo Casenghi1 • Marzia Colopi1 • Katia Bontempi2 • Camillo Autore1 • Massimo Volpe1,3 • Beatrice Musumeci1
Received: 16 December 2016 / Accepted: 19 January 2017 Ó Springer International Publishing Switzerland 2017
Abstract Introduction Acute coronary syndromes (ACS) in young patients are uncommon and their influence on morbidity and mortality in this population is still debated. Aim 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 B45 years (young adults), 1116 were [45 and \75 years (older adults) and 464 were C75 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). & Beatrice Musumeci [email protected] 1
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
2
Department of Epidemiology, Lazio Regional Health Service, Rome, Italy
3
IRCCS Neuromed, Pozzilli, IS, Italy
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. Keywords Acute coronary syndromes Myocardial infarction Young Outcome Diabetes
1 Introduction Coronary artery disease (CAD) and myocardial infarction (MI) affect mostly subjects aged more than 45 years, and are rarely seen in the so-called young adults. The rate of acute coronary syndromes (ACS) in patients aged B45 years is estimated to be between 2 and 10% [1–6], while in patients \35 years between 0.7 and 2% [7, 8] and in patients \30 years at 0.4% [9]. Even though patients aged B45 years account for a small proportion of all patients with ACS, young adults are of particular interest for different reasons: first, in this population myocardial infarction may have distinctive features compared with patients [45 years; further, it may influen
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