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162 Cardio Diabetes Medicine 2017

STEMI in Young

Dr. Joy M Thomas,
MD, MD, DM ( Cardiology), FRCP (G), FACC, FHRS, FCSI.
Chief Cardiologist (Adult Cardiology) & Chief Electrophysiologist.
Dr. M Anand,
MD., DM (Cardiology), Junior Consultant.
Frontier Lifeline Hospital, R-130-C, Ambattur Industrial Estate Road, Chennai 600101.

Introduction constraints and thus greater mortality. 5,6
Acute myocardial infarction (AMI) is a major cause
of death worldwide. The incidence of AMI in adults Definition of STEMI in young
younger than 45 years of age is less when compared There is no universal definition for who constitutes
to elderly age group people. The Framingham study young people. Studies in western countries consider
reported a ten-year incidence rate of myocardial in- ACS occurring in people less than 55 years of age
farction (MI) of 12.9 % in men 30 - 34 years old and 5.2 as young. Indian studies have taken age less than 45
% in women of 35 to 44 years old . AMI among young years or 40 years as young. Most of the studies use
1
patients aged 40 years or younger is rare, accounting the age cut off of 45 years to define young patients.
for approximately 2% to 6% of all cases . However
1,2
in recent times the incidence of AMI in young is in- Clinical presentation
creasing as shown by various studies.
The spectrum of CAD in India is different from west-
AMI in young is more important in clinical and soci- ern countries. In India, 60% of ACS (Acute coronary
etal interest because of the potential of premature syndrome) patients present with STEMI when com-
death and long-term disability with the resultant loss pared to less than 40% of ACS patients in developed
to family and society. Moreover, they are an import- countries presenting with STEMI.
ant group to examine with regard to risk factor mod- A cross-sectional study from tertiary care centre from
ification and secondary prevention.
Kerala show that male patients present at a younger
7
The mechanism and disease course of AMI in the age than females . 64% of males present with STEMI
young are likely to be different from those in the older while 38% of females present with NSTEMI or UA
population. The lifestyles of young people, character- (Unstable angina). The major risk factors in STEMI in
ized by high work stress, overwork, physical inactivi- young are smoking, dyslipidemia and family history
ty,unhealthy diet, smoking and drinking alcohol likely of CAD. In one study from Christian Medical College,
cause coronary atherosclerosis, which increases the Vellore, STEMI in young was seen in 8%. Most com-
incidenceof AMI . Hence, a better understanding of mon territory involved is AWMI (61%) followed by IWMI
3
8
the causes and mechanisms in these young patients (38%) . Coronary Angiogram revealed single vessel
7
helps in the management and prevention of AMI. disease in 51% of males and 30% of females . Triple
vessel disease was seen in 21% of males and 38% of
CAD in India females. Young patients do not experience anginal
pain antecedent to the MI (less than 12%). Presence
Global Burden of Diseases (GBD) Study has reported
that from year 1990 to 2013, CAD (Coronary artery of antecedent angina improves ischemic precondi-
disease) in India increased to become the number tioning and this major advantage is lost in the young
one cause of death . This study also reported that MI patients.
4
number of patients with IHD increased from less than Most of the young patients seek medical attention
a million to 2 million. IHD in India is characterized very late due to ignorance on the part of the patient
byincreasing numbers, regional variations, premature and also the attending physician. Appropriate treat-
onset, poor management aggravated by resource ment received by the young STEMI patients in the

GCDC 2017