Features and Long-Term Outcomes of Young Adults Undergoing Coronary Angiography for Coronary Artery Disease

Background: Contemporary data on the clinical profiles and long-term outcomes of young adults with coronary artery disease (CAD) related syndromes are limited.

Methods: We retrospectively investigated all patients aged ≤35 years undergoing coronary angiography in a single center during the years 2000-2017 (140/22,137 pateints, 0.63%). Patients with discharge diagnosis of acute myocarditis, non-ischemic cardiomyopathy or valvular/congenital heart disease (n=32) were excluded. Cardiac outcomes over a mean follow-up period of 9 years were evaluated.

Results: Coronary angiography was performed in 108 patients: 67 presented with acute coronary syndrome (ACS) (UAP/NSTEMI 25, STEMI 42) and 41 with non-ACS. Mean age was 32±3 years and 88% were males. Major risk factors were similar between the 2 groups and included dyslipidemia (69%), positive family history (64%), current smoking (61%), obesity (39%), hypertension (32%) and diabetes (22%). Eight of the ACS patients (12%) and 29 of the non-ACS (71%) had normal coronary arteries on index angiography, without any future cardiac event during follow-up. Of those with angiographic evidence of CAD, outcomes were similar in ACS vs non-ACS presentations (revascularization 41% vs 58%, myocardial infarction 32% vs 33% and all-cause death 8.5% vs 8.3%). A quarter of the patients with CAD met a clinical criteria of probable/definite familial hypercholesterolemia (FH), with particularly higher rates of myocardial infarction or revascularization during follow-up (figure). Only 17% of patients with evidence of CAD attained LDL-cholesterol treatment goals under 70 mg/dl.

Conclusions: Young adults undergoing coronary angiography for known or suspected CAD were predominantly male with a high burden of traditional cardiovascular risk factors. Angiographic evidence of CAD was associated with high rates of adverse cardiac events during long-term follow-up, regardless of acuity of presentation, and especially in patients with familial hypercholesterolemia. These data emphasize the importance of preventive interventions and addressing cardiovascular risk factors at a young age.