Risk Factors and Angiographic Syntax Score among Young Adults and Middleaged Patients with Acute Coronary Syndrome: A Cross-sectional Study

Introduction: Cardiovascular Disease (CVD) has become a major clinical and public health problem, with an increasing incidence and prevalence, particularly among the young adult population. Although there are well-established prevention strategies for reducing the incidence of Coronary Artery Disease (CAD), their effectiveness is diminished by several risk factors. Aim: To investigate traditional and lifestyle CVD risk factors in young adults (18-30 years) and middle-aged (31-45 years) patients and to correlate them with the angiographic profile using the syntax score in these patients. Materials and Methods: The study was designed as a cross-sectional study conducted at the Cardiology Department, Sri Venkateswara Institute of Medical Sciences (SVIMS), Tirupati, Andhra Pradesh, India, a teritary care teaching hospital during the period of August 2021 to July 2022. A total of 87 patients were included based on the study criteria. The study population was divided into two groups: Group-I (18-30 years) and Group-II (31-45 years). After obtaining informed consent, details regarding coronary risk factors such as smoking, Diabetes Mellitus (DM), hypertension, dyslipidaemia, obesity, family history of CAD, and details including physical inactivity were recorded. Coronary Angiography (CAG) was performed to determine obstructive coronary lesions, and the syntax score was calculated. All the collected data were recorded in Excel spreadsheets, and statistical analysis was carried out using Statistical Packages for Social Sciences version 25.0 software. Results: A male preponderance was observed in the study population (84%) with a mean age of 38.7±5.5 years, and the youngest patient was a 19-year-old female. The majority of patients, 79 (90.8%), were in the middle-age group. Dyslipidaemia (94%) was the predominant modifiable risk factor in the study population (p<0.05), followed by obesity (65.5%). About half of the patients had smoking as the predisposing risk factor for CAD. The majority of patients presented with ST Elevation Myocardial Infarction (STEMI) (76.9%). Single Vessel Disease (SVD) was the most common finding (70.1%), and the common culprit vessel was the Left Anterior Descending (LAD) artery (24.1%). The angiographic syntax score was low (<16) in 70 (80.5%) of the patients, with only 6 (7%) of the patients having a higher syntax score (>22). The correlation of the mean syntax score with risk factors has shown an association with obesity (10.6), physical inactivity (10.6), followed by diabetes (10.5). Conclusion: The study showed that middle age, male gender, and lifestyle risk factors including dyslipidaemia, obesity, physical inactivity, and smoking seem to correlate with angiographic lesions and CAD incidence. Therefore, the inclusion of healthy lifestyle changes such as regular physical activity and the control of modifiable risk factors, including smoking cessation, in this vulnerable middle-aged group is warranted.