Department of cardiology, Aga Khan University Kenya, P.O. Box 30270 - 00100, Nairobi, Kenya.
BMC Cardiovasc Disord. 2024 Apr 3;24(1):192. doi: 10.1186/s12872-024-03832-z.
Acute coronary syndrome (ACS) accounts for coronary artery disease (CAD) -related morbidity and mortality. There has been growing concern about the rising incidence of ACS among young individuals globally both in developed and developing countries, including Sub-Saharan Africa. This group's phenotypic characteristics; risk factors and clinical outcomes are not well described. contextual and regional studies are necessary to understand the magnitude of ACS among young Individuals and help highlight challenges and opportunities for improved ACS outcomes in the region. The study aimed to describe the demographic and clinical characteristics of young individuals hospitalized with ACS and report on in-hospital outcomes.
This single-center retrospective study was conducted at the Aga Khan University Hospital, Nairobi. Medical records of all young individuals hospitalized with ACS from 30th June 2020 to 1st May 2023 were reviewed. We defined young individuals as 50 years or below. Categorical variables were reported as frequencies and proportions, and compared with Pearson chi- square or Fisher's exact tests. Continuous variables were reported as means or medians and compared with independent t-tests or Mann-Whitney U tests. P- value < 0.05 was considered statistically significant.
Among 506 patients hospitalized with ACS, (n = 138,27.2%) were aged 50 years and below. The study population was male (n = 107, 79.9%) and African(n = 82,61.2%) predominant with a median age of 46.5 years (IQR 41.0-50.0). Hypertension (n = 101,75.4%) was noted in most study participants. More than half of the cohort were smokers (n = 69,51.5%) having a family history of premature ASCVD(n = 70,52.2%) and were on lipid-lowering therapy(n = 68,50.7%) prior to presentation. ST-segment-elevation myocardial infarction (STEMI) was the most common clinical manifestation of ACS (n = 77, 57.5%). Of the significant coronary artery disease (n = 75,56.0%), the majority of the individuals had single vessel disease (n = 60, 80%) with a predilection of left anterior deciding artery(n = 47,62.6%). The Main cause of ACS was atherosclerosis (n = 41,54.6%). The mean left ventricular ejection fraction was 46.0 (± 12.4). The in-hospital mortality was (n = 2, 1.5%).
This study highlights that young individuals contribute to a relatively large proportion of patients presenting with ACS at our center. The most common presentation was STEMI. The principal cause was atherosclerosis. The findings of this study highlight the importance of developing systems of care that enable the early detection of CAD. Traditional cardiovascular risk factors were prevalent and modifiable, thus targets of intervention.
急性冠状动脉综合征（ACS）是导致与冠心病（CAD）相关的发病率和死亡率的主要原因。在发达国家和发展中国家，包括撒哈拉以南非洲地区，全球范围内年轻人 ACS 的发病率不断上升，这引起了越来越多的关注。该人群的表型特征、危险因素和临床结局尚未得到充分描述。需要开展基于具体情况和区域性的研究，以了解年轻人 ACS 的发病程度，并有助于突出该地区改善 ACS 结局所面临的挑战和机遇。本研究旨在描述因 ACS 住院的年轻患者的人口统计学和临床特征，并报告院内结局。
这是一项在肯尼亚内罗毕阿迦汗大学医院进行的单中心回顾性研究。我们对 2020 年 6 月 30 日至 2023 年 5 月 1 日期间因 ACS 住院的所有年轻患者的病历进行了回顾性分析。我们将年龄在 50 岁及以下的患者定义为年轻人。分类变量以频率和比例报告，并采用 Pearson 卡方检验或 Fisher 确切检验进行比较。连续变量以均值或中位数报告，并采用独立 t 检验或 Mann-Whitney U 检验进行比较。P 值<0.05 被认为具有统计学意义。
在因 ACS 住院的 506 名患者中，（n=138，27.2%）年龄在 50 岁及以下。研究人群中男性（n=107，79.9%）居多，且以非洲裔（n=82，61.2%）为主，中位年龄为 46.5 岁（IQR 41.0-50.0）。大多数研究参与者存在高血压（n=101，75.4%）。超过一半的患者为吸烟者（n=69，51.5%），有早发性 ASCVD 家族史（n=70，52.2%），且在就诊前接受降脂治疗（n=68，50.7%）。ST 段抬高型心肌梗死（STEMI）是 ACS 最常见的临床表现（n=77，57.5%）。在有显著 CAD（n=75，56.0%）的患者中，大多数患者存在单支血管病变（n=60，80%），且以左前降支病变为主（n=47，62.6%）。ACS 的主要病因是动脉粥样硬化（n=41，54.6%）。左心室射血分数的平均值为 46.0（±12.4）。院内死亡率为 1.5%（n=2）。
本研究表明，年轻人在我们中心因 ACS 住院的比例相对较高。最常见的表现是 STEMI。主要病因是动脉粥样硬化。本研究结果强调了建立能够早期发现 CAD 的护理系统的重要性。传统的心血管危险因素普遍存在且可改变，因此是干预的目标。
