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STEMI in Young 163

form of primary PCI (percutaneous intervention) or vessel disease and predominantly involvement of left
thrombolysis is also less. In a study only 10.7% re- anterior descending artery.
ceived PCI and 4% received thrombolysis. National Coronary involvement other than atherosclerosis
registry data from 89 cities suggest that Indian pa- can occur but infrequent. It includes coronary vaso-
tients with STEMI fail to receive an adequate reperfu- spasm (Printzmetal angina), drug abuse like cocaine
sion therapy . Thrombolysis is received by less than use, amphetamine, alcohol and tobacco, congenital
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60% of Indian patients. The important reasons for not coronary artery anomalies like anomalous origin with
receiving reperfusion therapy was late presentation, intramural course, ALCAPA (Anomalous origin of left
consequent to delayed diagnosis and referral, poor coronary artery from pulmonary artery), coronary AV
transport facilities and lack of awareness in the gen- fistula, coronary ectasia, coronary artery aneurysm
eral population.
occurring as a sequalae to childhood Kawasaki dis-
ease, coronary arteritis occurring with connective
RISK FACTORS tissue diseases like rheumatoid arthritis, SLE (Sys-
In most of the studies conducted all around the world temic lupus erythematosus), ankylosing spondylitis,
on myocardial infarction in the young, the most com- psoriatic arthritis and Takayasu arteritis. Connective
monly observed risk factors were smoking, sedentary tissue diseases leads to premature atherosclerosis.
lifestyle with obesity and family history of coronary Hypercoagulant states also predisposes to coronary
artery disease. In India according to the CAD regis- thrombosis. Some of the hypercoagulant states are
try, moderate to high psychosocial stress level was APLA (Antiphospholipid antibody syndrome), ne-
found in 56% of young CAD . Males had a higher phrotic syndrome, protein S and protein C deficien-
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incidence of family history of CAD when compared cy, Factor V leiden mutation.
to females (72% vs 28%). Significant proportion of
participants had modifiable risk factors: hypertension Smoking adversely affects all phases of athero-
49.3%, diabetes 44.2%, dyslipidemia 11.4%, smoking sclerosis given that it hastens thrombotic process,
and/or tobacco use 38.6%, overweight/obesity in instigates endothelial dysfunction, augments proin-
56.3% and sedentary habits in 19.5%. Women,as com- flammatory effects, and induces coronary vasocon-
pared to men, had greater prevalence of diabetes striction even in patients with normal coronary vas-
(62.1%vs37.1%, p<0.001), hypertension (72.1%vs 40.3%, culature.
p<0.0001) and overweight/obesity (60.1 vs 35.2%,
p<0.0001), whereas men had greater prevalence of STEMI with angiographically normal
smoking/tobacco use (52.7 vs 3.2%, p<0.0001).In an coronary arteries
analysis of risk factors of STEMI in young patients in This scenario is more common in STEMI in young
Chinese population showed that levels of HbA1c and and exact pathophysiology is unclear. Possible
Fib were independent risk factors for STEMI in young mechanisms put forward are – coronary vasospasm,
patients and they proposed that these can be used recanalised thrombus with mild residual atheroma,
as risk markers of CAD in the young. embolization or a combination of these.

Angiographic Findings In-hospital course and short term outcome
Angiography in young patients with STEMI reveal one Fibrinolytic therapy in young adults has compara-
of the following pictures ble effects to that of adults with STEMI. In-hospital
1. Normal coronaries incidence of heart failure, death, repeat revasculari-
sation, stroke and major bleeding were lower when
2. Coronary artery disease of various etiologies
compared to older patients . However the readmis-
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Coronary Artery disease sion rates were higher in those who continued to
smoke and it is not related to severity of coronary
Atherosclerosis is the most common cause for artery disease but due to low left ventricular ejection
STEMI in young. However the atheroma in the young fraction. This finding underscores the need for inten-
is different from older people with more thrombus sive efforts to reduce smoking.
containing lesion which are usually discrete and sin-
gle vessel involvement. On the other hand, the older Collateral vessels in young patients
people have diffuse disease with multivessel involve-
ment. The young patients have a prothrombotic state Rentrop had described in 1987 that Chronic myocar-
attributable to smoking. The various studies have dial ischemia is a stimulus for the formation of col-
shown that most of the young patients have single lateral vessels in patients. Diabetes has been found

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