Comparison of Prevalence, Presentation and Prognosis of Acute Coronary Syndromes in ≤35 years, 36 – 54 years, and ≥ 55 years Patients.

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Whether very young patients (≤35-year-old) differ in the prevalence, presentation and prognosis of ACS is not well known. Out of 43,446 patients who were referred to a tertiary care cardiac catheterization laboratory between 1/1/2006 and 6/30/2017, 26,545 patients were ACS (defined as ST Elevation MI (STEMI), Non-ST Elevation MI (NSTEMI) or unstable angina pectoris). Detailed chart review was performed and characteristics at baseline were compared for ages ≤35 years, ages 36-54 years and ages ≥55 years. A total of 291 (1.1%) were ≤35-year-old, 7649 (28.8) were 36-54-year-old and 18605 (70.1%) were ≥55-year-old. ACS patients aged ≤35-year-old, were more likely to be men, Caucasian white, smoker, obese and have family history of coronary artery disease and less likely to have comorbidities such as hypertension, diabetes mellitus, hyperlipidemia compared with older patients. They were also more likely to present with elevated troponin levels than other groups. They also tended to present with late ST elevation myocardial infarction and were more likely to receive bare metal stents than older individuals. The prevalence of 2- and 3-vessel disease was lower compared with older individuals. They also had higher prevalence of cardiogenic shock. Compared with 36-54-year-old patients, ≤35-year-old were at significant higher risk of 30-day mortality in a multivariable adjusted regression model (Odds ratio 5.65, 95% confidence interval 2.49 – 12.82, p <0.001). Very young patients comprised ∼1% of all ACS cases but had much more prevalence of modifiable risk factors and significantly worse mortality. Modifying these risk factors may mitigate the risk in these patients and should be studied in the future.

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