Acute coronary syndrome in young adults: The Thai ACS registry

Background: There are few data regarding acute coronary syndrome (ACS) in young adults. ACS in young adults may have some characteristics that are different from those in older patients. Objective: The purpose of the present study was to assess the frequency, risk factors, presenting symptoms, treatment, complications and in-hospital outcomes of young patients with ACS in Thailand compared with those of older patients. Material and Method: From the Thai ACS registry database of 9,373 consecutive patients admitted to participating hospitals between August 1, 2002 and October 31, 2005, the authors divided patients into three age categories: < 45 years, 45-54 years and > 54 years. Risk factors, presenting symptoms, type of ACS, management, complications and in-hospital outcomes of the 3 age groups were analyzed. Results: Young patients comprised of 5.8% (544 patients) of all ACS patients. Discharge diagnosis in the young group was ST segment elevation myocardial infarction (STEMI) in 67%, non-ST segment elevation myocardial infarction (NSTEMI) 20% and unstable angina 14%. The young patients were more likely to have an STEMI than their elder counterparts. Risk factors such as tobacco use and a family history were more frequent in the young patients, whereas diabetes and hypertension were less frequent. Importantly, 66% of the patients aged <45 years had a history of tobacco use. A higher percentage of the young patients underwent coronary angiography, percutaneous coronary intervention and received aspirin, thienopyridines, GP IIb/ IIIa antagonists, beta-blockers and statins. In STEMI patients, reperfusion therapy was given more frequently in the patients aged < 45 years. Younger patients had a lower in-hospital mortality rate, lower incidence of congestive heart failure and a shorter length of stay. Multivariable analysis of in-hospital mortality revealed that older age remained an independent predictor of death. Conclusion: In Thailand, 5.8% of patients with ACS are under the age of 45 years old. The frequency of risk factors in the young patients differs from those in their elderly counterparts. The current management and aggressive risk factor modification are quite good and the overall mortality is lower in young adults with ACS compared to their elder counterparts. Primary preventive measures aimed at preventing our youth from adopting tobacco use should be implemented nationally.