Acute myocardial infarction in very young adults: A clinical presentation, risk factors, hospital outcome index, and their angiographic characteristics in North India - AMIYA Study

BACKGROUND: India is currently in the fourth stage of epidemiological transitions where cardiovascular disease is the leading cause of mortality and morbidity. Purpose of the present study was to assess the risk factors, clinical presentation, angiographic profile including severity, and in-hospital outcome of very young adults (aged ≤ ۳۰ years) with first acute myocardial infarction (AMI). METHODS: Total of ۱,۱۱۶ consecutive patients with ST-segment elevation acute myocardial infarction (STEMI) were studied between March ۲۰۱۳ and February ۲۰۱۵ at LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India. RESULTS: Mean age of the patients was ۲۶.۳ years. Risk factors were smoking (۷۸.۵%), family history of premature coronary artery disease (CAD) (۴۶.۸%), obesity (۳۹.۱%), physical inactivity (۳۸.۷%) and stressful life events (۲۹.۶%). The most common symptom and presentation was chest pain and anterior wall MI (AWMI) in ۹۴.۸% and ۵۸.۸%, respectively. About ۸۰.۶% of patients had obstructive CAD with single vessel disease (۵۷.۶%), double-vessel disease (۱۲.۹%) and left main involvement (۳.۲%). Left anterior descending (LAD) was commonest culprit artery (۵۸.۱%) followed by right coronary artery in ۲۸.۲%. In-hospital mortality was ۲.۸%. Percutaneous coronary intervention was performed in ۷۱.۶% of patients. Median number and length of stent were ۱.۱۸ and ۲۸ ± ۱۶ mm, respectively. CONCLUSION: AMI in very young adult occurred most commonly in male. Smoking was the most common risk factor. AWMI owing to LAD artery involvement was the most common presentation. Mean time of presentation after symptom onset was ۱۶.۹ hours. In contrast to western population, it is characterised by earlier onset, delayed presentation, more severity, diffuse disease, and more morbidity but with favourable in-hospital mortality 

Keywords:

Myocardial Infarction , Angiography , Percutaneous Coronary Intervention , Young Adults