Acute coronary syndrome in young adult and old age [comparative study]

ABSTRACT

Clinical characteristics as well as biochemical profile and angiographic findings in patients with acute coronary syndrome may differ in young compared to old patients. We compared clinical, laboratory and angiographic characteristics in forty four patients with acute coronary syndrome at age patients at age > 50 years [group II]. All patients presented by acute coronary syndrome and admitted to the coronary care unit at Bab-Elsharia University Hospital. The two patients groups were compared in coronary risk factors and angiographic features. STEMI were [43.2% vs 28.6%], NSTEMI [9.1% vs 7.l%] and UA [47.7% vs 643%] with no statistical significance. Smokers were high in GI [47.7% vs 35.7%] and non smokers were high in GII[45.5% vs 62.5%] with no statistical significance and the smoking index is more in Gil [1262.1 + 618.9] than GI [946.67 +/- 514.3] mostly due to longer duration of smoking. No statistical significance as regard hypertension [27.3 vs 42.9%] and DM [25% vs 32.1%] but the duration of DM has great trend in GII [7.94 +/- 6.08 II vs 5.91 +/- 4.39] [p value 0.06]. Among the diabetic patients; five [8.9%] in GII had retinopathy [p value < 0.05]. No statistical significance as regard past history of ischemic events or family history of premature coronary artery disease. There is significant correlation between LDL level and age of the patients [56.8% vs 76.8%] [p value = 0.05]. Serum TG was [59% vs 44.6%] with no statistical significant difference were detected [p value > 0.05]. The mean number of risk factors was 2.068 +/- 1.265 vs 2.143 +/- 1.368 with no statistical significance. In coronary angiography ectatic vessels with no significant stenotic lesions were [13.6% vs 5.4%] while myocardial bridge were [11.4% vs 7.1%]. Ostial and/or proximal lesions present in [31.8% vs 51.7%] while twenty six mid and/or distal lesions in [59.l% vs 78.6%] with no statistical significance. One vessel disease in [34.1% vs 30.3%], 2 vessels [11.4% vs 25%], three vessels [13.6% vs 12.5%] and more than three diseased vessels [6.8% vs 12.5%] p value > 0.05. Mean% narrowing of significant stenosis was in GI 82.915 +/- 15.821 vs 1181.114 +/- 16.286 with [p value > 0.05] but the number of segments was more in GI with p value 0.049. We still have much to learn about the pathophysiology of the acute coronary syndrome especially among thee young Egyptian patients. Age difference in acute coronary syndrome of Egyptian patients has no influence on other traditional risk factors although high prevalence of other risk factors in old age group especially serum level of low density lipoprotein [LDL-c], duration of diabetes mellitus and its micro-vascular complications may be related to long duration of these factors