A study of the clinical profile and angiographic treatment patterns of patients less than 30 years of age who had presented with acute myocardial infarction or heart attack at Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) between 1978 and 2017 has reported 30% mortality within 10 years and a whopping 48% in 20 years.
The high mortality rate in this small group of young coronary artery disease (CAD) patients, which is much higher than the mortality rate among older patients, is a matter of grave concern.
The study appears in the latest issue of the Indian Journal of Medical Research.
Modifiable risk factors
“This is a very important group of patients whose disease is eminently preventable through the modification of risk factors. One important factor which contributed to the high mortality in this age group was late presentation at the hospital, with 38% patients arriving at the hospital after the window period for primary interventions such as thrombolysis or angioplasty. This delay in seeking medical care led to their poor outcome. More awareness should be created in the community of the possibility of cardiac events occurring in the young age group also and that medical attention should not be delayed,” S. Harikrishnan, Professor of Cardiology, SCTIMST, said.
During the 40-year period between 1978-2017, 271 patients less than 30 years of age reached the department of Cardiology at the SCTIMST with a diagnosis of CAD. Of these, 159 patients underwent coronary angiography and constituted the study group.
Data from the young patients with CAD remain scarce, particularly regarding their long-term outcomes.
Potentially modifiable major cardiovascular risk factors (smoking, systemic hypertension, diabetes mellitus, high blood cholesterol, alcohol use or obesity) were associated with 95% of patients with symptomatic CAD. Only seven patients (4.4%) did not have any of the risk factors.
A total of 82% of these patients presented at the hospital with acute myocardial infarction. On follow up, it was found that 34% of patients continued to smoke even after their first cardiac event while 17% continued their alcohol habits at long term follow up.
More than half of the patients remained physically inactive, and 79% had inadequate intake of fruits and vegetables at long-term follow up. Importantly, 41% of patients discontinued their prescribed medications for the reason that they did not experience any symptoms. The implications of non-adherence in the young population could be catastrophic, researchers said. Latest follow-up data were available in 92% patients. Forty-one patients died during follow up.
Among those who were alive on follow up, 16 recurrent acute coronary events were documented in 14 patients, 18 patients (12%) developed heart failure on follow up, 16 of whom expired.
‘Don’t ignore symptoms’
“The study results point to the need for heightened efforts for preventive strategies in the community. There needs to be more awareness in the community of the possibility of CAD in this very young age group. The important message is that chest pain or atypical symptoms of CAD in youngsters should not be ignored as early medical intervention can give much better outcomes,” Arun Gopalakrishnan, Assistant Professor of Cardiology, SCTIMST.