Long-term outcomes and risk factors in young adults with acute coronary syndrome: a decade of experience

Acute Coronary Syndrome (ACS) incidence in younger populations has been increasing worldwide. Several aspects remain unclear despite young individuals presenting distinct risk profiles compared to their older counterparts. A comprehensive understanding of the evolving characteristics and treatment options is crucial to address the burden of ACS in this population. However, data regarding long-term follow-up and prognosis in young adults remain limited.

Describe the demographic, clinical characteristics, and outcomes, including major adverse cardiovascular events (MACE), in young individuals hospitalized with ACS.

We conducted a retrospective, single-center study of young individuals hospitalized with ACS between January 1, 2013, and October 30, 2023. We defined young individuals as 45 years or below. We analyzed demographics, clinical characteristics, and outcomes, including MACE, defined as the composite of all-cause mortality, myocardial infarction, stroke, and hospitalization due to heart failure.

A total of 130 patients were included, with a median follow-up of 4.5 years (SD 2.9). The majority were male (77.7%), with a mean age of 41.8 years (SD 4.2). Nearly all patients (97.9%) had at least one traditional cardiovascular risk factor. The most prevalent were overweight or obesity (75.2%), dyslipidemia (74.6%), hypertension (30.8%), diabetes (20%), family history of premature ACS (20%), and smoking (79.2%). Less common comorbidities included drug use (11.5%), autoimmune diseases (2.3%), and inflammatory conditions (0.8%). The cohort's clinical presentation included STEMI (60.8%), NSTEMI (30%), and unstable angina (9.2%). Cardiorespiratory arrest occurred in 3.1% of cases at presentation. Most patients had single-vessel disease (74.6%), predominantly involving the left anterior descending artery (61.5%). Atherosclerosis was the primary cause of ACS (76.9%), followed by in-stent restenosis (8.5%), embolism (5.4%), and spontaneous coronary artery dissection (2.3%). During follow-up, 17.7% of patients experienced MACE, with cardiovascular mortality at 5.4% and recurrent myocardial infarction at 10.8%. In a multivariate analysis, no significant associations were found between demographic characteristics, risk factors, or clinical presentation and the development of MACE.

Young adults with ACS face a substantial risk of major cardiovascular events and premature mortality during long-term follow-up, with a high rate of recurrent events. Early morbidity and mortality significantly impact their most productive years. Cardiovascular risk factors such as smoking, obesity, and dyslipidemia should not be underestimated in young individuals. Further studies are needed to explore the potential benefits of primary prevention strategies in this high-risk population.