Long Term Prognosis in Very Young Patient with Acute Coronary Syndrome

Background: Acute coronary syndrome in very young age is uncommon. Young patients with ACS have unique characteristics. Limited information is available about the long-term follow-up and prognosis in these patients.

Aim: To evaluate the long-term clinical outcomes of patients with ACS at very young age, and assess factors that predict long-term prognosis.

Methods: We retrospectively analyzed 165 young patients(men

Results: The mean follow-up was 9.4±4.4 years(IQR: [6.25, 12.25]). Most patients were men(88%) and 51.9% were from Arab origin. Culprit lesion in the LAD artery was more common among Arabs compare to Jews(55.2% vs 32.8% p<0.0098).

Fifteen patients died(9.1%) during follow-up. Mortality rate was higher among Arabs compare to Jews (13.4% vs 4.8%, p<0.062), in diabetic patients compare to nondiabetic patients(23.8% vs 7.3% respectively, p<0.035) and in patients with LAD involvment(15.1% vs 4.3%, p<0.026).

Most of the patients(66.4%) had at least one major cardiovascular event during the follow-up. Death and/or MACE occurred in 71.8% of the patients. In multivariate analysis the strongest predictors for MACE or death were LAD artery involvement(HR 2.29; 95% CI 1.39 to 3.76), hypertension(HR 2.15; 95% CI 1.25 to 3.69) and PCI without stent insertion(HR 2.41; 95% CI 1.41 to 4.11).The mean number of events was 1.847±0.15 events per patient. Event rate per patient-year was 0.276±0.04. Hypertension was the strongest predictor for high event rate(0.31±0.107, p<0.004).

Conclusions: The rate of recurrent events in patients who presented with ACS in a very young age is relatively high during long term follow-up. Early intervention to reduce risk factors and to improve compliance may lead to a better prognosis in this special and important population.