PATTERN OF CORONARY ARTERY DISEASE WITH NO RISK FACTORS UNDER AGE 35 YEARS
Abstract
Background: Coronary artery disease (CAD) is no more deemed to be an ailment of the 4th or5th decade; rather an earlier age incidence is not infrequently encountered in our population.However, there are a few data regarding CAD in young adults, and much about its underlyingpathology still remains undetermined. The objective of this study was to delineate the coronaryarterial disease pattern in adults under the age of 35 years, but having no known coronary riskfactors. Methods: This prospective study was conducted at the Cardiology Departments of all 3public sector tertiary care hospitals in Peshawar from Jun 2008 to Dec 2009. After havingexcluded the traditional risk factors for CAD, patients under the age of 35 years with objectiveevidence of CAD were subjected to percutaneous coronary angiography. Results: Out of a totalof 104 patients, 85 (81.73%) patients were men, and 19 (18.27%) were women. The mean ageof the whole group was 32.66±3.237 (22–35) years. Significant CAD (>50% diameternarrowing of at least one major coronary artery) was found in 87 (83.7%) patients while 17(16.3%) patients had non-atherosclerotic coronary artery disease, including 12 (11.53%) patientshaving normal coronary arteries, 1 (1%) patient had anomalous origin of right coronary artery(RCA), 1 (1%) patient had coronary arteritis, 2 (1.92%) patients had coronary artery ectasia, and1 (1%) patient had a myocardial bridge over left anterior descending artery (LAD). Among thepatients with significant CAD, the prevalence rate of one, two and three vessel disease was 54(51.9%), 22 (21.2%) and 11 (10.6%) respectively. Almost 50% of the lesions occurred in LADfollowed by 25% in RCA and 20% in circumflex, while only one patient (1%) had isolatedsignificant CAD of left main coronary artery. Osteal segments were involved in 10%, proximalin 61%, mid in 21% and distal segments in 7% of the lesions. Conclusion: In the younger agegroup, CAD is mostly a disease of men, single vessel CAD predominates with LADinvolvement mostly, predominant osteal to proximal segment involvement of vessels, and amuch higher incidence of normal coronaries and non-obstructive CAD is met with.Keywords: Coronary Artery Disease (CAD), Myocardial infarction (MI), CoronaryAngiography, Risk FactorsReferences
Lopez AD, Mathers CD, Ezzati M. Global and regional
burden of disease and risk factors, 2001: systematic analysis
of population health data. Lancet 2006;367:1747–57.
Gupta M, Singh N, Verma S. South Asians and
cardiovascular risk: what clinicians should know. Circulation
;113:924–9.
Joshi P, Islam S, Pais P, Reddy S, Dorairaj P, Kazmi K, et al.
Risk factors for early myocardial infarction in South Asians
compared with individuals in other countries. JAMA
;297:286–94.
Ahmad I, Shafique Q. Myocardial infarction under age 40:
risk factors and coronary arteriographic findings. Ann King
Edward Med Coll 2004;9:262–5.
Al-Khadra AH. Clinical profile of young patients with acute
myocardial infarction in Saudi Arabia. Int J Cardiol. 2003
Sep;91(1):9–13.
Abid AR, Ali A, Mohyuddin T, Naveed S, Tarin SMA,
Azhar M. Acute myocardial infarction; evidence for sex-age
interaction. Professional Med J 2006;13(2);178–85.
Siwach SB, Singh H, Sharma D, Katyal VK. Profile of young
acute myocardial infarction in Harayana. J Assoc Physicians
India 1998;46(5):424–6.
Imaazio M, Bobbio M, Bergerone S, Barlera S, Maggioni
AP. Clinical and epidemiological characteristics of juvenile
myocardial infarction in Italy: the GISSI experience. G Ital
Cardiol 1998;28(5):505–12.
Al-Koubaisy OK, Mehdi RS, Arern FD, Ahmed IT.
Cineangiographic findings in young Iraqi men with first
acute myocardial infarction. Cathet Cardiovasc Diagn
;19:87–90.
Cole JH, Miller JI 3rd, Sperling LS, Weintraub WS. Longterm follow-up of coronary artery disease presenting in
young adults. J Am Coll Cardiol 2003;41:521–8.
Doughty M, Mehta R, Bruckman D, Das S, Karavite D, Tsai
T, et al. Acute myocardial infarction in the young – The
University of Michigan experience. Am Heart J
;143(1):56–62.
Fournier JA, Sanchez A, Quero J, Fernandez-Cortacero JA,
Gonzalez-Barrero A. Myocardial infarction in men aged 40
years or less; a prospective clinical-angiographic study.
Clinical Cardiology 1996;19:631–6.
Kanitz MG, Giovannucci SI, Jones JS, Molt M. Myocardial
infarction in young adults: Risk factors and clinical features.
J Emerg Med 1996;14:139–45.
Chen L, Chester M, Kaski JC. Clinical factors and
angiographic features associated with premature coronary
artery disease. Chest 1995;108(2):364–9.
Zimmerman FH, Cameron A, Fisher LD, Ng G. Myocardial
infarction in young adults: Angiographic characterization,
risk factors and prognosis(Coronary Artery Surgery
Registry). J Am Coll Cardiol 1995;26(3):654–61.
Wolfe MW, Vacek JL. Myocardial infarction in the young.
Angiographic features and risk factor analysis of patients
with myocardial infarction at or before the age of 35 years.
Chest 1988;94(5):926–30.
Sanchez Calle JM, de Mora M, Hernandez JM. Acute
myocardial infarction in young adults: analysis of risk factors
and coronary angiography. Arch Inst Cardiol Mex
;61:225–9.
Warren SE, Thompson SI, Vieweg WV. Historic and
angiographic features of young adults surviving myocardial
infarction. Chest 1979;75:667–70.
Rumboldt Z, Rumboldt M, Pesenti S, Polic S, Miric D.
Peculiarities of myocardial infarction at young age in
Southern Croatia.Cardiologica 1995;40:407–11.
J Ayub Med Coll Abbottabad 2010;22(4)
http://www.ayubmed.edu.pk/JAMC/PAST/22-4/Lubna.pdf 119
Khan MA, Hassan MU, Hafizullah M. Coronary artery
disease, is it more frequently affecting younger age group
and women? Pakistan Heart Journal 2006;39:17–21.
Choudhury L, Marsh JD. Myocardial infarction in young
patients. Am J Med 1999;107(3):254–61.
Wei JY, Bulkley BH. Myocardial infarction before age 36
years in women: Predominance of non-atherosclerotic events.
Am Heart J 1982;3(104):561–6.
Javed A, Aziz S. Pattern of coronary artery involvement in
females with acute/subacute chest pain. Ann Pak Inst Med
Sci 2006;2:247–50.
Waters DD, Halphen C, Theroux P, Paul-Robert D, Mizgala
HF. Coronary artery disease in young women: clinical and
angiographic features and correlation with risk factors. Am J
Cardiol 1978;42:41–7.
Welch CC, Proudfit WE, Sheldon WC. Coronary
arteriographic findings in 1000 women under age 50. Am J
Cardiol 1975;35:211–5.
De Wood MA, Spores J, Notske R, Mouser LT. Burroughs R,
Golden MS, Lang HT. Prevalence of total coronary occlusion
during the early hours of transmural myocardial infarction. N
Engl J Med 1980;303:897–902.
Kapoor AS. Assessment, risk stratification, and prognosis of
young patients after myocardial infarction. Cardiovasc Rev
and Rpts 1986;7:226–39.
Wang K, Asinger RW, Marriott HJL. ST-Segment Elevation
in Conditions Other Than Acute Myocardial Infarction. N
Engl J Med 2003;349:2128–35.
Published
Issue
Section
License
Journal of Ayub Medical College, Abbottabad is an OPEN ACCESS JOURNAL which means that all content is FREELY available without charge to all users whether registered with the journal or not. The work published by J Ayub Med Coll Abbottabad is licensed and distributed under the creative commons License CC BY ND Attribution-NoDerivs. Material printed in this journal is OPEN to access, and are FREE for use in academic and research work with proper citation. J Ayub Med Coll Abbottabad accepts only original material for publication with the understanding that except for abstracts, no part of the data has been published or will be submitted for publication elsewhere before appearing in J Ayub Med Coll Abbottabad. The Editorial Board of J Ayub Med Coll Abbottabad makes every effort to ensure the accuracy and authenticity of material printed in J Ayub Med Coll Abbottabad. However, conclusions and statements expressed are views of the authors and do not reflect the opinion/policy of J Ayub Med Coll Abbottabad or the Editorial Board.
USERS are allowed to read, download, copy, distribute, print, search, or link to the full texts of the articles, or use them for any other lawful purpose, without asking prior permission from the publisher or the author. This is in accordance with the BOAI definition of open access.
AUTHORS retain the rights of free downloading/unlimited e-print of full text and sharing/disseminating the article without any restriction, by any means including twitter, scholarly collaboration networks such as ResearchGate, Academia.eu, and social media sites such as Twitter, LinkedIn, Google Scholar and any other professional or academic networking site.
