Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan.
Department of Adult Cardiology, National Institute of Cardiovascular Diseases, Karachi, Pakistan.
Am J Cardiol. 2023 Oct 15;205:190-197. doi: 10.1016/j.amjcard.2023.07.138. Epub 2023 Aug 21.
The incidence of premature ischemic heart disease (IHD) is increasing because of urbanization, a sedentary lifestyle, and various other unexplored factors, especially in South Asia. This study aimed to assess the distribution of premature ST-elevation acute coronary syndrome (STE-ACS) with its clinical and angiographic pattern along with hospital course in a contemporary cohort of patients who underwent primary percutaneous intervention at a tertiary care center in the South Asian region. We included consecutive patients of either gender diagnosed with STE-ACS and who underwent primary percutaneous intervention. Patients were stratified based on age as ≤40 years (young) and >40 years (old). Clinical characteristics, angiographic patterns, and hospital course were compared between the 2 groups. Of the total of 4,686 patients, 466 (9.9%) were young (≤40 years). Young patients had a lower prevalence of hypertension (40.8% vs 54.5%, p <0.001), diabetes (26.6% vs 36.4%, p <0.001), metabolic syndrome (14.8% vs 24%, p <0.001), history of IHD (5.8% vs 9.3%, p = 0.013) and a higher frequency of smoking (33% vs 24.7%, p <0.001), positive family history (8.2% vs 3.2%, p <0.001), and single-vessel involvement (60.1% vs 33.2%, p <0.001). The composite adverse clinical outcome occurrence was significantly lower in young patients (14.2% vs 19.5%, p = 0.006). On multivariable analysis, history of IHD in young, whereas age, Killip class III/IV, intubated, arrhythmias on arrival, diabetes, history of IHD, pre-procedure left ventricular end-diastolic pressure, ejection fraction <40%, and slow flow/no-reflow during the procedure were found to be the independent predictors of adverse clinical outcome in old patients. In conclusion, we have a substantial burden of premature STE-ACS, mostly in male patients potentially driven by smoking and positive family history. Despite favorable pathophysiology, with mostly single-vessel hospital courses of STE-ACS in the young equally lethal in nature.
由于城市化、 sedentary lifestyle 和其他各种尚未探索的因素，包括南亚在内的过早缺血性心脏病 (IHD) 的发病率正在上升。本研究旨在评估在南亚地区一家三级护理中心接受经皮冠状动脉介入治疗的患者中，具有临床和血管造影模式的过早 ST 段抬高急性冠状动脉综合征 (STE-ACS) 的分布情况，以及住院过程。我们纳入了连续诊断为 STE-ACS 并接受经皮冠状动脉介入治疗的任何性别的患者。根据年龄分为≤40 岁（年轻）和>40 岁（年老）两组。比较两组之间的临床特征、血管造影模式和住院过程。在总共 4686 名患者中，有 466 名（9.9%）为年轻患者（≤40 岁）。年轻患者高血压（40.8% vs 54.5%，p<0.001）、糖尿病（26.6% vs 36.4%，p<0.001）、代谢综合征（14.8% vs 24%，p<0.001）、冠心病史（5.8% vs 9.3%，p=0.013）和吸烟史（33% vs 24.7%，p<0.001）的发生率较低，阳性家族史（8.2% vs 3.2%，p<0.001）和单支血管受累（60.1% vs 33.2%，p<0.001）的频率较高。年轻患者的复合不良临床结局发生率明显较低（14.2% vs 19.5%，p=0.006）。多变量分析显示，年轻患者的冠心病史，而年龄、Killip 分级 III/IV、插管、入院时心律失常、糖尿病、冠心病史、术前左心室舒张末期压、射血分数<40%和术中慢血流/无复流是老年患者不良临床结局的独立预测因素。结论：我们有大量的过早 STE-ACS 负担，主要发生在男性患者，可能由吸烟和阳性家族史引起。尽管病理生理学有利，年轻患者的 STE-ACS 主要为单支血管病变，但同样具有致命性。
