Young onset coronary artery disease in India: A descriptive observational study

Abstract

Introduction

Coronary Artery Disease (CAD) in less than 45 years of age is termed as young onset CAD. There is an alarming increase in young-onset CAD in Low- and Middle-Income countries, especially in the Asian Subcontinent.

Aim and objectives

The study aimed to estimate the clinical profile, risk factors, and post-angiography outcome at six months among young-onset CAD patients.

Method

A prospective study was conducted at a national, tertiary care, government referral hospital in North India, from October 2022 to November 2023. All patients undergoing coronary angiography following CAD and less than 45 years of age were enrolled after obtaining informed consent. Data was collected using a structured pilot-tested interviewer-administered questionnaire and review of medical records and analysed using R version 4.2.3.

Results

The study included 55 patients with a mean age of 39.2 years and majority being males. The common risk factors observed were smoking (36.3 %) and dyslipidemia (9 %). Most of the participants presented with dyspnea and chest pain together (30.9 %). The NYHA class at presentation was class III (73 %). 5.5 % had thrombocytopenia, transaminitis was in 14.5 % and 36.7 % had dyslipidemia. CRP was increased in 52.7 % and abnormal cardiac markers in (63.6 %). The ECG showed ST depression, T Inversion (51 %), ST elevation (29 %), left ventricle hypertrophy in 3.7 %. Chest x-ray showed cardiomegaly in 16.4 %. Coronary angiography showed that among total patients 60 % had single vessel disease, 21.8 % had double vessel disease and 18.2 % had triple vessel disease. Further 32.7 % were diagnosed NSTEMI, 29.1 % with STEMI and 16.4 % each had stable and unstable angina respectively. 20 % had EF 45%–55 %, 11 % had EF <45 %+ hypokinesia, 5.5 % had EF <45 %, 3.6 % each had EF 45%–55 %+ hypokinesia and EF <45 %+ Hypokinesia + Valvular insufficiency respectively and 1.8 % had EF <45 %+ valvular insufficiency. Angioplasty was done in 81.8 % and CABG in 14.5 %. At the 6th month of follow up NYHA grading was class I in 56.6 % and class II in 37.8 % and class III in 5.6 %. The mortality rate was 3.6 % (2 deaths) because of cardiac failure.

Conclusion

The study concludes that six month survival for the diagnosis was 96.4 %. Modifiable risk factors (such as smoking, dyslipidemia, obesity) and non modifiable risk factors (sex and family history) both are directly associated with early Coronary artery disease. Majority of the patients presented with chest pain and dyspnea. The common biochemical derangements found were elevated CRP and cardiac biomarkers. In non invasive tests ECG and 2D Echocardiography were found to be good tools for evaluation of CAD as ECG changes such as ST elevation, T wave inversion, ST depression etc and 2D Echo findings like Reduced ejection fraction and regional wall motion abnormalities have been recorded in most of the patients. Angioplasty was done and after performing angioplasty patients showed improvement. At 6 months follow up NYHA score significantly improved i. e. Class 1 and class 2, and the patients were asymptomatic. During study among 55 patients 2 deaths were reported mainly because of cardiac failure.