SPC365

Young patients with ACS: Who are they and where are they going?

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Carolina Saleiro

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Posters
FP Number: ---
Authors: Carolina Saleiro; João Lopes; Joana m Ribeiro; Diana de Campos; Luis Puga; Ana rm Gomes; José p Sousa; Marco Costa; Lino Gonçalves

<p style="margin-left:-19px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Introduction: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Younger patients with acute coronary syndromes (ACS) are a particular population. Besides having a longer life expectancy, they are at an increased risk for long term cardiovascular (CV) events. </span></span></span></span></p>

<p style="margin-left:-19px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Aim: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">To identify the main characteristics of young patients with ACS and to assess the predictors of worse long-term outcomes in this subset of patients.<strong> </strong></span></span></span></span></p>

<p style="margin-left:-19px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Methods:</span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif"> ACS patients younger than 45 years admitted to a single coronary care unit were included (n=74). Patients with non-obstructive coronary arteries were excluded (n=12). C<span style="color:black">linical, laboratorial and echocardiographic data were evaluated. </span>The primary endpoint was a composite of all-cause mortality, reinfarction and heart failure hospitalization. Cox regression was conducted to evaluate the impact on the primary endpoint. The mean follow-up time was 65 (&plusmn; 30) months.</span></span></span></span></p>

<p style="margin-left:-19px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Results: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Sixty-one (82%) patients were male, with a mean age of 41&plusmn;2 years old. Most of them were smokers (87%) and had dyslipidaemia (70%); diabetes (22%) and hypertension (42%) were also prevalent, considering the age range. ST-elevation myocardial infarction (STEMI) was the most common presentation (67%); </span></span><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">mean hospital stay was 4&plusmn;3 days. The culprit coronary vessel was the left anterior descendent in 41%; the left circumflex in 30%, the right coronary artery in 18% and the left main in 3% of the patients. Percutaneous coronary intervention was performed in 92% of the cases. Fifty-seven percent of the patients had a preserved left ventricular ejection fraction. Most patients remained Killip-Kimball class I during hospitalization (91%). Three patients received levosimendan and 1 received an intraaortic balloon-pump. One patient died during hospitalization. The composite endpoint occurred in 14 (18%) patients. Cox analysis showed that peak Troponin I (HR 1.01, 95% CI 1.003-1.01, per each unit increase) and NT-proBNP (HR 1.00, 95% CI 1.001-1.001, per each unit increase) were the only predictors of MACE. Neither clinical (age, gender, CV risk factors, left ventricular ejection fraction), nor procedural factors (culprit vessel, treatment strategy) were predictors of the composite endpoint. </span></span></span></span></p>

<p style="margin-left:-19px; text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">Conclusion: </span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Arial&quot;,sans-serif">In our cohort, young patients with ACS were mostly men with comorbidity with CV risk factors. and frequently presented with<strong> </strong>STEMI. The occurrence of long-term MACE was frequent and independently predicted by peak troponin I and NT-proBNP levels at admission. </span></span></span></span></p>