YOUNG ACS AUDIT

S. Aravindakumar

Chief Consultant Interventional Cardiologist, Kauvery Hospitals, Trichy

Young, less than 40

Aged less than 30: 7%
Predominantly: Males
Smokers: 25%
DM: 41%
HTN: 33%
DLP: LDL55 mg after 1 month for secondary prevention almost 100%.

Family history of CAD 45 years for males and 55 years for females – 3%
Recurrent MI: 1%
Other vascular disease: Nil
Physical inactivity:10%
Alcohol: 25%
Lack of sleep: Nil

Tachycardic: 66 percent
Shock: 6%
Desaturation: 7%

Predominantly radial approach
No imaging
Pharmacoinvasive in 25%
Primary PCI: 31%
PCI in all
No CABG
Single stent: 78%
Double stent: 22%

Primary VT: 5%
Complete heart block: 2%
Stent thrombosis: NIL
Dialysis: NIL

Hypokalemia: 19%
Stress hyperglycemia: 19%
Triple vessel disease: 8%
Double vessel disease: 22%
Mortality: 1%

Limitations

No imaging done which could have given pathology of ACS
Only risk factor analysis done
Incidence and prevalence not studied
Long term follow up not here
Non traditional risk factors not studied

Positives

Most patients had only traditional risk factors
Our system of management is exemplary where mortality rate is less than 1%
Being a small place pain to hospital time was less
Emergency services and cathlab services were extraordinary

Alarming Outcomes

High incidence of ACS for single hospital ,single consultant was very high.
60% patient had DM or stress hyperglycemia
25% had obesity and hypertension
High prevalance of smoking and alcohol
High incidence of NSTEMI
High incidence of double vessel and triple vessel disease

Concerns

1) Recurrence rates always high, despite medical therapy;

2) Recurrent events generally occurred from new coronary lesions, which confirms prior work showing that non-obstructive plaques are the vulnerable ones, more prone to rapid progression

3) Clinical factors associated with recurrence were insufficient control of conventional risk factors (diabetes, hypertension and smoking), multivessel disease,

4) Smoking was the strongest modifiable factor for recurrent MACE.

In sum, this study helped shed light on risk factors associated with progression and opportunities for enhanced prevention.