Clinical And Angiographic Profile Of Young Patients Presenting With Spontaneous Electrocardiogram Resolution Of St-Segment Elevation (Spontaneous Aborted) Myocardial Infarction: A Substudy Of The Premature Coronary Artery Disease Registry (Registered Under [Ctri/2018/03/012544])

Background: There are very few data regarding clinically defined spontaneous resolution (SR) in ST-segment elevation (STE) acute coronary syndrome (ACS) patients. Most recent European and American practice guidelines fail to give specific recommendations for these patients. Specifically, the timing of intervention in patients with SR remains unclear. Aim and Study: The aim of the study was to study the clinical, social, biochemical, and angiographic profile of Indian youth presenting with spontaneous resolution (SR) of ST-segment elevation (STE). Subjects and Methods: The premature coronary artery disease (PCAD) registry is a prospective, descriptive, observational study of Indians aged below 40 years with coronary artery disease (CAD) conducted between April 2017 and April 2020. Of 3450 patients registered in PCAD registry, a total of 41 (1.2%) out of these 3450 patients presented with STE myocardial infarction (MI), which resolved spontaneously, and hence these patients satisfied entry criteria. Entire clinical and angiographic profile of these patients was documented. Conventional lipids were estimated using commercially available kits. The data were analyzed by statistical software R version 3.5.0 (R Core Team (2018). R: A language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, Austria). Results: The mean age of all patients under PCAD registry was 30.49 years. A majority of 38 (92.68%) of the patients were males, 30 (73.17%) were smokers. Of total, four patients (9.75%) were diabetic. Twenty-five out of 41 patients (60.97%) were coming under the below poverty line category. Five patients (12.19%) were Muslims by religion, whereas the remaining were Hindus. The majority (38 patients, 92.68%) were nonvegetarians. The most common index presentation of the transient STE was with anterior wall MI (27 patients, 65.85%). The mean total cholesterol of the entire study population was 172.947 +/- 47.11. Thirty-nine out of 41 patients (95.12%) underwent diagnostic coronary angiogram. Ultimately, 32 out of 41 patients (78.05%) were discharged and continued on optimal medical therapy and follow-up and nine patients (21.95%) underwent percutaneous coronary revascularization. Conclusions: Patients with ACS and SR of ST-elevation on electrocardiogram (ECG) exhibit a characteristic profile that differentiates them from the rest of patients with STEMI: younger age, a greater prevalence of males and smokers, and a lesser elevation of the necrosis markers, a greater ejection fraction, and a higher prevalence of single-vessel disease. Contrary to popular belief, coronary angiogram showed a significant proportion of them to be having underlying organic CAD. Our study highlights the need for early intervention in such patients.