Acute Coronary Syndrome in Young Adults: The Thai ACS Registry
Wiwun Tungsubutra MD*, Damras Tresukosol MD*, Wacin Buddhari MD**, Watana Boonsom MD***, Sopon Sanguanwang MD****, Boonchu Srichaiveth MD*****
Affiliation : * Division of Cardiology, Department of Medicine, Faculty of Medicine, Siriraj Hospital, Bangkok ** Division of Cardiology, Department of Medicine, King Chulalongkorn Memorial Hospital, Bangkok *** Department of Medicine, BMA Medical College and Vajira Hospital, Bangkok **** Division of Cardiovascular Disease, Department of Medicine, Phramongkutklao Hospital, Bangkok *****Bangkok General Hospital, Bangkok
Background : There are few data regarding acute coronary syndrome (ACS) in young adults. ACS in young
adults may have some characteristics that are different from those in older patients.
Objective : The purpose of the present study was to assess the frequency, risk factors, presenting symptoms,
treatment, complications and in-hospital outcomes of young patients with ACS in Thailand compared with
those of older patients.
Materials and Methods : From the Thai ACS registry database of 9,373 consecutive patients admitted to partici-
pating hospitals between August 1, 2002 and October 31, 2005, the authors divided patients into three age
categories: < 45 years, 45-54 years and > 54 years. Risk factors, presenting symptoms, type of ACS, manage-
ment, complications and in-hospital outcomes of the 3 age groups were analyzed.
Results : Young patients comprised of 5.8% (544 patients) of all ACS patients. Discharge diagnosis in the
young group was ST segment elevation myocardial infarction (STEMI) in 67%, non-ST segment elevation
myocardial infarction (NSTEMI) 20% and unstable angina 14%. The young patients were more likely to have
an STEMI than their elder counterparts. Risk factors such as tobacco use and a family history were more
frequent in the young patients, whereas diabetes and hypertension were less frequent. Importantly, 66% of the
patients aged <45 years had a history of tobacco use. A higher percentage of the young patients underwent
coronary angiography, percutaneous coronary intervention and received aspirin, thienopyridines, GP IIb/
IIIa antagonists, beta-blockers and statins. In STEMI patients, reperfusion therapy was given more frequently
in the patients aged < 45 years. Younger patients had a lower in-hospital mortality rate, lower incidence of
congestive heart failure and a shorter length of stay. Multivariable analysis of in-hospital mortality revealed
that older age remained an independent predictor of death.
Conclusion : In Thailand, 5.8% of patients with ACS are under the age of 45 years old. The frequency of risk
factors in the young patients differs from those in their elderly counterparts. The current management and
aggressive risk factor modification are quite good and the overall mortality is lower in young adults with ACS
compared to their elder counterparts. Primary preventive measures aimed at preventing our youth from
adopting tobacco use should be implemented nationally.
Keywords : Acute coronary syndrome, Acute myocardial infarction, Young adults
