A surge in prevalence and factors affecting early onset acute coronary syndrome

Acute coronary syndrome (ACS) with early onset of age (especially in 30 years) is an infrequent (up to 0.05 to 0.4%) but serious entity, with modest available data. A rise in incidence has been witnessed, especially in South Asia. The aim was to ascertain the proportion of very young patients (<= 35 years) among all adult patients with ACS and important factors associated with it. Patients presenting with ACS during September 2020 to January 2021 were incorporated in this cross-sectional single-center study and were analyzed by age: Group I (20-35 years), Group II (36-45 years), and Group III (>45 years). Demographic characteristics, angiographic findings, co-morbidities and treatment strategies were recorded. 1314 patients with ACS in the study period were examined. Patients in Group I accounted for 6.2% (81) of the study cohort. Of these, 2.1% (28) were aged 20 to 30 years and 4.03% (53) were aged 30 to 35 years. Analysis of age groups by ACS risk factors revealed that male gender, overweight, smoking, using smokeless tobacco (especially gutka), were significantly higher in Group I. Other conventional risk factors were more prevalent in Group III. In Group 1, anterior wall myocardial infarction, single vessel coronary artery disease (SVCAD) and re-canalized vessels were significantly more frequent. Significantly higher proportion of patients were treated with conservative management alone in Group I. In our crossectional study we report an inclining shift in the frequency of early onset ACS than previously observed. In this recent cohort, ACS in the youngest adult patients was significantly associated with being overweight, smoking, and smokeless tobacco use, especially gutka. Moreover, these patients' higher rates of SVCAD and re-canalized vessels due to hypercoagulable milieu, could be better responsive to aggressive pharmacologic treatment noted in these young patients.