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Clinical and angiographic features of acute coronary syndrome in young adults: A Tunisian Cohort
Coronary heart disease Adresse e-mail : [email protected] (M. Dioum) Background Management of acute coronary syndromes with ST segment elevation (STEMI) is a race again time: time is myocardium». Treatment consist in reperfusion strategy by coronary intervention or thrombolysis. The main objective of this work was to evaluate the time delays of treatment and the extending factors during STEMI. Method It was a prospective, descriptive and analytic study on 6 months including all patients admitted for STEMI. We studied the time delays and the extending factors. Results We included 50 patients. The average age was 58,4 years and the sex ratio M/F was 2,5. Chest pain was typical for 39 patients. Mean time delay between pain onset and first medical contact was 12 h16 min. The first medical contact was a general physician for 33 patients and a cardiologist for 8 patients. The average time delay between the first medical contact and an electrocardiogram was 9 h57 min. The main factor of late diagnosis were unavailability of electrocardiograph and absence of prescription of an electrocardiogram. The average time delay between the diagnosis electrocardiogram and admission in cardiology department was 3 h02 min. The transport was the main extending factor. Aspirin and clopidogrel were used respectively for 17 and 10 patients. Among the patients admitted directly in cardiology, the average time delay for a diagnostic electrocardiogram was 30 min. Thrombolysis was performed in 17 patients within an average delay of 2 h11 min. A rupture of streptokinase was the most common extending factor. Twenty-three patients underwent percutaneous coronary intervention with a main time delay between diagnostic electrocardiogram and cath lab of 2 h42 min. The unavailability of medical team was the first extending factor. Conclusion Factors related to long delay in admission and care are a proof of lack of codified management of STEMI. It is necessary to develop the prehospital emergency medicine, educate population and medical staff. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.046 395
Acute coronary syndrome without ST segment elevation: Gender influence M. Drissa ∗ , M. Madiouni ∗ , M. Habiba ∗ Cardiologie la Rabta, Tunis, Tunisie ∗ Corresponding authors. Adresse e-mail : [email protected] (M. Drissa) Introduction Despite the persistent perception that CAD is a man’s disease, it is often the most common cause of death in women, responsible for 7 times more deaths than breast cancer. Methods We led a retrospective, observational and monocentric study including 120 patients (70 men and 50 women) admitted for NSTE -ACS to the cardiology department ‘‘Adultes’’ at the university hospital la Rabta between January 2010 and December 2017. All epidemiological, clinical, therapeutic and prognostic data were compared in a gender perspective. Results It was observed that women were more often hypertensive, sedentary, obese and with less smoking rates than men. Presentation and symptoms of coronary artery disease in women are often atypical and misleading. Despite their higher ischemic risk (64% for women versus 37% for men with high risk criteria) (P = 0,01), women seem to benefit less of invasive strategy. Coronary angiography when performed often shows non-obstructive coronary disease (16% in women versus 6% in men) and a coronary revascularization is less frequently proposed in women (67% versus 85%) (P = 0,001). Women were generally more at risk for long-term events than men. They had more combined events (death/angina recurrence/revascularization) during the course of the evolution with a
23 significant difference (68% in women versus 40% in men) (P = 0,04) and a higher 1-year mortality rate. But at the end of our analysis, the female sex does not appear as an independent predictor of mortality at 1 year. Conclusion In spite of its importance and major impact, CAD in women is under-diagnosed and often associated to higher risk criteria than men. Yet, women remain undertreated with less adequate therapeutic strategies responsible for a poorer prognosis in the long term and a higher mortality rate. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.047 416
Clinical and angiographic features of acute coronary syndrome in young adults: A Tunisian Cohort W. Ouechtati ben Attia ∗ , M. Chebbi , E. Allouche , A. Rekik , H. Ben Ahmed , L. Bezdah Cardiologie, hopital Charles-Nicolle Tunis, Tunis, Tunisie ∗ Corresponding author. Adresse e-mail : ouechtati [email protected] (W. Ouechtati ben Attia) Introduction Acute coronary syndrome (ACS) in young adults seems to be not as low as expected. It presents one of the highly debated issues in cardiology according to the increasing number of those patients. Objective The aim of our study was to describe the clinical and angiographic profile in young patient ≤ 40 years diagnosed with ACS. Methods We performed a retrospective study including 74 patients younger than 40 years of age with clinical and electrocardiographic evidence of ACS, hospitalized in our cardiology department from January 2016 to Mach 2019. All patients underwent a coronary angiography. We analyzed the risk factors, clinical profile, type of ACS and angiographic features of these patients. Results Mean age was 33 ± 7 years old [26-40] and 94% of them were males (five women versus 70 men). All men were smokers, including four man addicted on cannabis, and only two women were non-smokers. The most common risk factors were diabetes mellitus (14 patients; 19%), systemic hypertension (10 patients; 13.5%), dyslipidemia (7 patients; 9.4%), obesity (7 patients; 9.4%) and a family history of premature coronary artery disease (5 patients; 6.7%). Ten patients (13.5%) were having ST segment elevation myocardial infraction, 13 patients (17.5%) were hospitalized for a non-ST segment elevation and 51 patients (69%) have a history of an unstable angina. The most common abnormal arteriography findings were the involvement of one vessel (23 patients; 31%), followed by doublevessel disease noticed in two cases (2.7%). There was one patient of our population with three-vessel disease (1.3%). The most common vessel to be involved was the left anterior descending (12 cases; 16%). Normal coronary angiography was noticed in 37 patients (50%). Conclusion ACS in young patients has a huge impact on the patient, the society and the economic burden. It presents a real challenge that the cardiologist must be aware of in order to set on the ideal therapeutic strategy including the perfect clinical management and an early prevention program to control the cardiovascular risk factors. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.048
Acute coronary syndrome without ST segment elevation: Gender influence M. Drissa ∗ , M. Madiouni ∗ , M. Habiba ∗ Cardiologie la Rabta, Tunis, Tunisie ∗ Corresponding authors. Adresse e-mail : [email protected] (M. Drissa) Introduction Despite the persistent perception that CAD is a man’s disease, it is often the most common cause of death in women, responsible for 7 times more deaths than breast cancer. Methods We led a retrospective, observational and monocentric study including 120 patients (70 men and 50 women) admitted for NSTE -ACS to the cardiology department ‘‘Adultes’’ at the university hospital la Rabta between January 2010 and December 2017. All epidemiological, clinical, therapeutic and prognostic data were compared in a gender perspective. Results It was observed that women were more often hypertensive, sedentary, obese and with less smoking rates than men. Presentation and symptoms of coronary artery disease in women are often atypical and misleading. Despite their higher ischemic risk (64% for women versus 37% for men with high risk criteria) (P = 0,01), women seem to benefit less of invasive strategy. Coronary angiography when performed often shows non-obstructive coronary disease (16% in women versus 6% in men) and a coronary revascularization is less frequently proposed in women (67% versus 85%) (P = 0,001). Women were generally more at risk for long-term events than men. They had more combined events (death/angina recurrence/revascularization) during the course of the evolution with a
23 significant difference (68% in women versus 40% in men) (P = 0,04) and a higher 1-year mortality rate. But at the end of our analysis, the female sex does not appear as an independent predictor of mortality at 1 year. Conclusion In spite of its importance and major impact, CAD in women is under-diagnosed and often associated to higher risk criteria than men. Yet, women remain undertreated with less adequate therapeutic strategies responsible for a poorer prognosis in the long term and a higher mortality rate. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.047 416
Clinical and angiographic features of acute coronary syndrome in young adults: A Tunisian Cohort W. Ouechtati ben Attia ∗ , M. Chebbi , E. Allouche , A. Rekik , H. Ben Ahmed , L. Bezdah Cardiologie, hopital Charles-Nicolle Tunis, Tunis, Tunisie ∗ Corresponding author. Adresse e-mail : ouechtati [email protected] (W. Ouechtati ben Attia) Introduction Acute coronary syndrome (ACS) in young adults seems to be not as low as expected. It presents one of the highly debated issues in cardiology according to the increasing number of those patients. Objective The aim of our study was to describe the clinical and angiographic profile in young patient ≤ 40 years diagnosed with ACS. Methods We performed a retrospective study including 74 patients younger than 40 years of age with clinical and electrocardiographic evidence of ACS, hospitalized in our cardiology department from January 2016 to Mach 2019. All patients underwent a coronary angiography. We analyzed the risk factors, clinical profile, type of ACS and angiographic features of these patients. Results Mean age was 33 ± 7 years old [26-40] and 94% of them were males (five women versus 70 men). All men were smokers, including four man addicted on cannabis, and only two women were non-smokers. The most common risk factors were diabetes mellitus (14 patients; 19%), systemic hypertension (10 patients; 13.5%), dyslipidemia (7 patients; 9.4%), obesity (7 patients; 9.4%) and a family history of premature coronary artery disease (5 patients; 6.7%). Ten patients (13.5%) were having ST segment elevation myocardial infraction, 13 patients (17.5%) were hospitalized for a non-ST segment elevation and 51 patients (69%) have a history of an unstable angina. The most common abnormal arteriography findings were the involvement of one vessel (23 patients; 31%), followed by doublevessel disease noticed in two cases (2.7%). There was one patient of our population with three-vessel disease (1.3%). The most common vessel to be involved was the left anterior descending (12 cases; 16%). Normal coronary angiography was noticed in 37 patients (50%). Conclusion ACS in young patients has a huge impact on the patient, the society and the economic burden. It presents a real challenge that the cardiologist must be aware of in order to set on the ideal therapeutic strategy including the perfect clinical management and an early prevention program to control the cardiovascular risk factors. Disclosure of interest The authors declare that they have no competing interest. https://doi.org/10.1016/j.acvdsp.2019.09.048