Long-Term Outcome of Acute Coronary Syndromes in Young Patients
Giacomo Tini1, Giulia Proietti1, Matteo Casenghi1
1Cardiology, 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.
Insights
Young adults experiencing acute coronary syndromes (ACS) have lower mortality than older adults, though similar morbidity. Diabetes is a key risk factor for poor outcomes in younger patients with ACS.
Area of Science:
- Cardiology
- Internal Medicine
- Public Health
Background:
- Acute coronary syndromes (ACS) are uncommon in young patients.
- The impact of ACS on morbidity and mortality in younger populations remains debated.
Purpose of the Study:
- To investigate clinical and angiographic characteristics, risk factors, and outcomes in young ACS patients compared to older adults.
- To evaluate survival free from death, nonfatal myocardial infarction (MI), or coronary revascularization.
- To identify specific risk factors influencing prognosis in young ACS patients.
Main Methods:
- Retrospective analysis of 1696 ACS patients diagnosed between 2007 and 2013.
- Categorization into young adults (≤45 years), older adults (>45 and <75 years), and elderly (≥75 years).
- Comparison of clinical features, risk factors, and 3-year composite endpoints between age groups.
Main Results:
- Young adults (≤45 years) presented with a higher prevalence of STEMI, fewer cardiovascular risk factors, and less extensive coronary artery disease.
- Survival free from the composite endpoint was significantly better in young adults (11.2%) compared to older adults (24.2%) (p=0.001), primarily due to lower mortality.
- Rates of nonfatal MI and coronary revascularization were similar between young and older adults. Diabetes emerged as the strongest independent risk factor for worse prognosis in the young cohort (OR 3.47; p=0.04).
Conclusions:
- Young adults with ACS exhibit distinct clinical profiles and experience lower mortality rates than older individuals.
- Morbidity rates, including nonfatal MI and revascularization, were comparable between young and older ACS patients.
- Diabetes independently predicts a worse prognosis in younger patients diagnosed with acute coronary syndromes.
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 ≤45 years (young adults), 1116 were >45 and <75 years (older adults) and 464 were ≥75 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).
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.
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