Profile of Sri Lankan patients with myocardial infarction at younger age

Introduction

Coronary Artery Disease (CAD) in the young is a frequently seen health burden in South Asia and it is essential to understand such patients’ profile in the local community.

Objectives

To evaluate the profile of young patients (age <45 years) with Myocardial Infarction (MI) presented to Teaching Hospital, Kandy.

Methods

Retrospective cross-sectional study was conducted on young patients who had acute coronary syndrome. It was conducted from January 2015 to March 2016 at the Cardiology Unit, Kandy.

Results

A total of 100 patients (84% of males) with a mean age of 39.84±6.9 years were reviewed. Smoking was the main risk factor (53%) followed by increased LDL [LDL >100mg/dl] (39%), diabetes (24%), hypertension (19%), and family history of CAD (11%). There were development of shock in 6% and arrhythmia in 5% of the study population following the MI.

Angiographically normal coronary arteries were found in 14%. There were 50% with significant coronary lesions (50-90% stenosis) and 58% with critical (≥ 90%) coronary obstruction. Bivascular and trivascular coronary lesions were recorded in 17% and 14% respectively, while the majority had univascular lesions (36%). Only 2% had significant left main stem involvement. Significant atherosclerotic coronary lesions mainly affected the left anterior descending artery (52%) followed by right coronary artery (36%) and left circumflex (18%) artery. There were 45% with Chronic Total Occlusions (CTOs), 6% with coronary artery ectasia and 1% with slow flow syndrome.

Conclusion

Univascular disease is frequent among young patients, in whom smoking and dyslipidemia are the commonest modifiable risk factors. Addressing these issues may play an important role in primary and secondary prevention.