Noor Lubna, Shah S Sadiq, Adnan Yasir, Sawar Shah, ud Din Shahab, Awan Zahid Aslam, Bangash Kamran, Ahmed Saeed, Dad Aqal
Department of Cardiology, Postgraduate Medical Institute, Hayatabad Medical Complex, Peshawar, Pakistan.
J Ayub Med Coll Abbottabad. 2010 Oct-Dec;22(4):115-9.
Coronary artery disease (CAD) is no more deemed to be an ailment of the 4th or 5th decade; rather an earlier age incidence is not infrequently encountered in our population. However, there are a few data regarding CAD in young adults, and much about its underlying pathology still remains undetermined. The objective of this study was to delineate the coronary arterial disease pattern in adults under the age of 35 years, but having no known coronary risk factors.
This prospective study was conducted at the Cardiology Departments of all 3 public sector tertiary care hospitals in Peshawar from Jun 2008 to Dec 2009. After having excluded the traditional risk factors for CAD, patients under the age of 35 years with objective evidence of CAD were subjected to percutaneous coronary angiography.
Out of a total of 104 patients, 85 (81.73%) patients were men, and 19 (18.27%) were women. The mean age of the whole group was 32.66 +/- 3.237 (22-35) years. Significant CAD (> 50% diameter narrowing of at least one major coronary artery) was found in 87 (83.7%) patients while 17 (16.3%) patients had non-atherosclerotic coronary artery disease, including 12 (11.53%) patients having normal coronary arteries, 1 (1%) patient had anomalous origin of right coronary artery (RCA), 1 (1%) patient had coronary arteritis, 2 (1.92%) patients had coronary artery ectasia, and 1 (1%) patient had a myocardial bridge over left anterior descending artery (LAD). Among the patients with significant CAD, the prevalence rate of one, two and three vessel disease was 54 (51.9%), 22 (21.2%) and 11 (10.6%) respectively. Almost 50% of the lesions occurred in LAD followed by 25% in RCA and 20% in circumflex, while only one patient (1%) had isolated significant CAD of left main coronary artery. Osteal segments were involved in 10%, proximal in 61%, mid in 21% and distal segments in 7% of the lesions.
In the younger age group, CAD is mostly a disease of men, single vessel CAD predominates with LAD involvement mostly, predominant osteal to proximal segment involvement of vessels, and a much higher incidence of normal coronaries and non-obstructive CAD is met with.
冠状动脉疾病（CAD）不再被认为是四五十岁人群的疾病；在我们的人群中，其发病年龄更早的情况并不少见。然而，关于年轻成年人CAD的数据较少，其潜在病理仍有许多未确定之处。本研究的目的是描绘35岁以下但无已知冠状动脉危险因素的成年人的冠状动脉疾病模式。
本前瞻性研究于2008年6月至2009年12月在白沙瓦所有3家公立三级医疗医院的心脏病科进行。在排除CAD的传统危险因素后，对35岁以下有CAD客观证据的患者进行经皮冠状动脉造影。
在总共104例患者中，85例（81.73%）为男性，19例（18.27%）为女性。整个组的平均年龄为32.66±3.237（22 - 35）岁。87例（83.7%）患者发现有显著CAD（至少一支主要冠状动脉直径狭窄>50%），而17例（16.3%）患者有非动脉粥样硬化性冠状动脉疾病，包括12例（11.53%）冠状动脉正常的患者，1例（1%）患者右冠状动脉（RCA）起源异常，1例（1%）患者有冠状动脉炎，2例（1.92%）患者有冠状动脉扩张，1例（1%）患者左前降支动脉（LAD）有心肌桥。在有显著CAD的患者中，单支、双支和三支血管疾病的患病率分别为54例（51.9%）、22例（21.2%）和11例（10.6%）。几乎50%的病变发生在LAD，其次是25%在RCA，20%在回旋支，而只有1例患者（1%）有孤立的左主冠状动脉显著CAD。10%的病变累及骨段，61%累及近端，21%累及中段，7%累及远端。
在较年轻的年龄组中，CAD主要是男性疾病，单支血管CAD为主，主要累及LAD，血管主要累及骨段至近端段，冠状动脉正常和非阻塞性CAD的发生率更高。
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