Acute coronary syndrome in patients under 35 years old

Objective. To evaluate the clinical and demographic characteristics of a group of patients under 35 years old admitted with acute coronary syndrome, as well as the features of coronary bed damage and endovascular treatment.

Material and methods. A retrospective analysis of the group of patients aged 30 to 35, admitted to the Regional Vascular Center with a diagnosis of acute coronary syndrome in the period from 2019 to June 2021, was carried out. The study included 72 patients with ACS, regardless of the ST segment changes on the electrocardiogram, were admitted to the hospital by the emergency medical service referral. Positive troponins were detected in all the patients by qualitative analysis. Upon admission, they were sent to a catheterization laboratory. An examination was carried out according to the recommendations of medical care, as well as selective coronary angiography and, if indicated, stenting of the coronary arteries was performed.

Results. When analyzing the clinical and demographic characteristics of the group, attention has been drawn to the absolute predominance of males — 71 (98.7%), urban residents — 64 (88.9%), low frequency of bad habits: tobacco smoking in 13 (18.1%) and alcohol abuse in 2 (2.8%) patients, the absence of concomitant pathology, a signifi cant time from the onset of symptoms to calling an ambulance (165 [90; 263]). According to the results of angiography, it should be noted the possibility of acute coronary syndrome with intact coronary arteries is 9 (27.3%) among all ACS cases with ST segment elevation and 29 (74.3%) with ACS without ST segment elevation, while in one third of the above episodes (13 (34.2%)) ACS was caused by the presence of a muscle “bridge” in the basin of the anterior descending artery, a concomitant phenomenon of slowed blood fl ow. The attention has been also drawn to the almost equal proportions of acute thrombotic occlusion (19 (55.9%)) and haemodynamically signifi cant hemadostenosis (14 (41.2%)) as the cause of ACS.

Conclusion. In patients under 35 years old with a typical clinical. picture, positive troponins, with a qualitative analysis, there is a high probability of pathological changes in the coronary bed, regardless of the ST segment changes, which requires X-ray endovascular methods of diagnosis and treatment. Angiographic features of the coronary artery lesion in young people are the discreteness of the lesion in the proximal or middle sections of the arteries, the high frequency of thrombotic occlusions, the predominant lesion of the anterior descending or right coronary arteries, the low frequency of calcifi cation of the coronary arteries.

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