Coronary Artery Disease in Patients Aged 35 or less - A Different Beast?
T Christus1, A M Shukkur, I Rashdan
1Department of Cardiology, Chest Diseases Hospital, Ministry of Health, Kuwait.
Insights
Coronary artery disease (CAD) is significant in young adults under 35, with smoking as a primary risk factor. Many require interventions like percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG).
Area of Science:
- Cardiology
- Vascular Medicine
- Public Health
Background:
- Coronary artery disease (CAD) typically affects older individuals.
- Early-onset CAD in young adults presents unique challenges and risk factor profiles.
- Understanding CAD in patients aged 35 or younger is crucial for targeted prevention and treatment strategies.
Purpose of the Study:
- To evaluate the extent and severity of coronary artery disease (CAD) in a cohort of 200 patients aged 35 years or younger.
- To identify the primary risk factors associated with premature CAD in this demographic.
- To determine the treatment outcomes for young patients diagnosed with CAD.
Main Methods:
- Retrospective analysis of coronary angiogram findings in 200 consecutive patients aged ≤35 years.
- Data collection included patient demographics, risk factors, CAD extent and severity, and treatment modalities.
- Statistical analysis of prevalence, risk factors, and intervention rates.
Main Results:
- Smoking (71%) and a history of premature CAD (27%) were the most common risk factors.
- A significant proportion of patients experienced ST-elevation myocardial infarction (STEMI) (68%), with moderate to large infarct sizes (54.3%).
- 15% had left main or triple-vessel CAD, while 23.5% had normal coronary angiograms; 45.5% required percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG).
Conclusions:
- Coronary artery disease (CAD) is notably severe and extensive in young adult patients (≤35 years).
- Smoking is identified as the predominant risk factor, underscoring the need for smoking cessation programs in younger populations.
- A substantial number of these young patients necessitate invasive procedures like PCI or CABG, highlighting the aggressive nature of early-onset CAD.
Aim:
To assess the extent and severity of coronary artery disease (CAD) in 200 consecutive patients aged 35 years or less undergoing diagnostic coronary angiography.
Patients And Methods:
Findings in these 200 patients (≤ 35 years of age) were analyzed to find the extent and severity of CAD. The mean age was 31.69 (±3.76) years. Majority were males (94%) and from the Arab ethnicity (70.5%).
Result:
Smoking (71%) and history of premature CAD (27%) were the most frequent risk factors (RF). History of previous ST elevation myocardial infarction (MI) was present in 68%. Anterior wall MI was the most frequent location (63.3%). The majority (54.3%) had moderate or large size MI. Ejection fraction (EF) less than 50% was noted in 30.3%. Left main or triple vessel CAD was seen in 15%. One- and two-vessel CAD was seen in 32.5% and 19% patients, respectively. Coronary angiogram was completely normal in 23.5%. The majority (54.5%) were treated conservatively and the rest (45.5%) needed percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG). The mean number of stents used was 1.3 ± 0.67 and the mean length of stents used was 20.3 ± 12.6 mm.
Conclusion:
The extent and severity of CAD was very significant in this subgroup of very young (≤35 years) Asian patients. Smoking was the main risk factor and half of the patients needed either PCI or CABG.
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