Salik Ur Rehman Iqbal1
1Aga Khan University Hospital, Karachi, Pakistan
Young STEMI patients generally have Single vessel disease (SVCAD). As South Asians have rising incidence of Young CAD, there is a need to further explore the trends of coronary lesions in this population. The goal of this study was to compare coronary lesions between young (<45 years) and Elder (>45 years) STEMI patients and to identify risk of developing certain lesions.
It was a prospective study done from 2013-2018 on patients aged 18-65 years who presented with STEMI and underwent emergent Coronary Catheterization and Intervention. Patients with prior MI, revascularization or dialysis patients were excluded.
Of 361 patients, 151 were aged <45 years (mean: 39.4 vs. 59.9 years). They were mostly men (90.0% vs. 72.0%, p=0.00), obese (51.0 % vs. 36.0%, p=0.01) and with a lower prevalence of hypertension (31.0 % vs. 57.0%, p=0.00). They mostly had SVCAD, (67% vs. 45%, p=0.00) with risk of SVCAD of 2.6 (CI 1.5-4.6) even after adjustment for Sex, Obesity, Diabetes, family history, Hypertension and Tobacco. In both groups, LAD was the most commonly involved vessel (78.2% vs. 74.8%, p=0.48) and risk of LAD disease was also similar (RR 0.7, CI: 0.4-1.4).
Double (2VCAD) and triple vessel disease (3VCAD) was mostly seen in Elders, (23% vs. 36%, p=0.00) and (8% vs. 18%, p=0.00) respectively. Risk of 3VCAD was 4.1 (CI: 1.8-9.3) in Elder patients whilst non-significant for 2VCAD between both groups. In Elder patients, risk of disease in Ostial-proximal LCx was 3.5 (CI: 1.6-7.3) and Ostial-Proximal RCA was 2.2 (CI: 1.2-4.2) respectively even after adjustment for above factors.
Young South Asian STEMI patients are Male, Obese and have elevated risk of SVCAD. LAD is most commonly involved. In Elder patients, after LAD, LCx followed by RCA are at risk for getting involved. Elder patients are more at risk for 3VCAD.