Abstract
Aims
Early onset acute coronary syndrome (ACS) is associated with a more aggressive evolution and its consequences can be devastating to the quality of life (QOL), affecting the patient’s psychology, ability to work, and the socioeconomic burden. In the last decade, the incidence of ACS in young patients (≤45 years old) is increased but unfortunately, little is known about long-term follow-up and impact on quality of life. The aim of this study was to analyse the clinical evolutions and the QOL in this specific group of patients.
Methods and results
We included 91 consecutive young patients (≤45 years at the time of presentation) with ACS referred from October 2013 until March 2021 to our clinic. All enrolled patients underwent angiography. We analysed the clinical presentation, echocardiography, and therapy at the time of discharge. Furthermore, patients underwent telephone follow-up after 40 months: new hospitalizations, cardiovascular events, bleeding, and relevant changes in medical therapy were investigated. In addition, patients were also invited to participate to a survey to investigate QOL, sexual, and socioeconomic changes after ACS. QOL was explored through the EQ-5D scale using the time trade-off (TTO) and visual analogue scale (VAS) technique based on European values. Mean age was 40.6 ± 3.6 years and 17.6% were women. Most patients had obstructive coronary artery disease at angiography (90.1%) and 85.7% underwent PCI. At a median follow-up of 40 months, major adverse cardiovascular events (MACE) a composite of death, myocardial infarction, stroke and definite stent thrombosis, occurred in 12% of patients (Figure 1). Patient reported bleeding occurred in 29.8%, while bleeding requiring hospitalization in 3.6%. Univariate predictors of MACE were previous stroke, Killip class at presentation, current drug use, left ventricle ejection fraction, wall motion score index (WMSI), and haemoglobin at admission. Young patients showed reduced levels of QOL (TTO: 0.85 ± 0.17—VAD: 0.79 ± 0.17), with higher levels among individuals without obstructive coronary artery disease (Figure 2). Predictors of lower quality of life were WMSI, left anterior descending (LAD) stenting, left ventricular aneurysm and ventricular thrombus (Figure 3). After 12 months from the index event, 31.5% of patients were still on dual antiplatelet therapy, and the mean number of medications was 4.65 ± 2.3.
Conclusions
In conclusion, young patients have a high residual risk of ischaemic and bleeding events and impaired QOL. Optimization of medical therapy and better patient information is of upmost importance to mitigate residual risk of adverse events.
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