Acute myocardial infarction in young adults of North East India : a clinical and angiographic study

Background/ Aims and Objectives : Acute myocardial infarction (AMI) in young adults (<40 years) is being increasingly encountered in recent years among the South Asian population, particularly in Indians and data regarding the presentation, risk factors and angiographic findings on this important subset of patients is lacking from the North-Eastern region of India. Paucity of published literature on young AMI patients from this part of the Country formed the basis for the present study. Material and Methods : A Prospective observational crosssectional analytical study was conducted on fifty young adults who were admitted with AMI over a period of 18 months. The clinical features, conventional cardiovascular risk factor profiles and pattern of coronary artery involvement on angiography were analysed and compared with fifty older patients (> 55 years) admitted concurrently during the study period. Results : Majority of the young patients were males (P < 0.05), presented with anterior wall ST elevation MI (P<0.05), had no history of antecedent angina prior to the AMI (P<0.05) and had a relatively presesrved left ventricular ejection fraction (P=NS) . Predominant cardiovascular risk factors present in this subset of the population were cigarette smoking, dyslipidaemia (P<0.05) and family history of premature CAD (P=NS). Hypertension and diabetes were less commonly encountered compared with the older population (P=<0.05). Single vessel disease (P<0.05), left anterior descending artery involvement (P<0.05) and angiographically normal coronary artery (P=NS) were more common in the young group. Left main, double and triple vessel disease were significantly more common in the older group (P<0.05). Conclusion : Our study confirms that smoking, dyslipidemia and family history of premature CAD are the major conventional cardiovascular risk factors present in young AMI patients of this region. Single vessel disease, mostly LAD artery involvement and angiographically normal coronary arteries are more prevalent. AMI in young occur more frequently in males as ST elevation MI without any prior history of angina and have a preserved left ventricular EF compared to older population. These findings provide vital information on young AMI patients amongst the diverse population of N-E India and will help to guide the treating physicians and the health care system to adopt appropriate steps directed towards primary and secondary prevention of premature CAD in young patients of this region. especially smoking cessation, which is the commonest modifiable risk factor, in their most productive years of life.