Coronary Artery Disease in Young Indians: A Different Entity

ABSTRACT

Objective: To study the angiographic profile, treatment andoutcome of Coronary Artery Disease (CAD) in young (< 45years) individuals in India.Methods: Consecutive 132 young adults with CAD reporting totwo tertiary care centres over a period of 1 ½ years wereenrolled as a case control observational study. Subjects whopresented with acute coronary syndrome (ACS), chronic stableangina (CSA), Heart failure or AsymptomaticElectrocardiogram (ECG) abnormalities but confirmed CAD onCoronary Angiogram (CAG) were included. Angiographicprofile, treatment and outcome were analysed with a follow upof one year.Results: Risk factors of abdominal obesity, lipoprotein (a)[Lp(a)] and tobacco consumption were significantly higher instudy group. ST elevation Myocardial Infarction (STEMI) wasthe commonest presentation (71.21%). Single vessel disease(56.06 %) was the commonest angiographic profile with LeftAnterior Descending Artery (LAD) involvement (40.91%).Primary Angioplasty in Myocardial Infarction (PAMI) was donein 42.5% of STEMI and Thrombolysis in 48.9%. Three types ofcoronary involvement were noticed with Type I having discretelesions/thrombus and Type III having multiple segment/arteryinvolvement with differing risk factor profile and outcome.Diffuse and more severe CAD was associated with tobaccouse, abdominal obesity and elevated Lp (a). Late presentation,diffuse disease and persistence of smoking predicted pooreroutcome.Conclusions: CAD in Young commonly presents with AcuteMI and single vessel LAD involvement. Less than half haveaccess to PAMI. Most require stenting although selectedpatients do well with intracoronary thrombolysis. Delayedtreatment and failure to modify risk factors portend badprognosis.