Bài giảng Acute coronary syndrome in young Cuban adults under 45 years old - Cardiology and cardiac surgery Institute, Havana Cuba

The lecture presents the content suboptimal implementation of prevention strategies and uncontrolled cardiovascular risk factors; atherosclerosis begins with the origin of life; statistics corresponding to patients admitted with acute coronary syndrome, institute of Cardiology, Havana Cuba...

Acute coronary syndrome in young Cuban adults under 45 years old Cardiology and cardiac

surgery Institute Havana Cuba.

Dr Piter Martínez Benítez.

Specialist in Cardiology Professor and researcher Cardiology and cardiac surgery Institute Havana Cuba.

Interventional Cardiologist Vietnam-Cuba Dong Hoi Friendship Hospital.

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❖ CVDs, diabetes, cancer, obesity and respiratory diseases, account for about 60% of the 56.5 million deaths each year, and almost half

of the global burden of disease Coronary heart disease will be the one of main causes.

❖ Although there has been substantial improvement in atherosclerotic cardiovascular disease outcomes in recent decades,

it remains the leading cause of morbidity and mortality globally.

Much of this attributable to suboptimal implementation of prevention strategies and uncontrolled cardiovascular risk factors.

When does the atherosclerosis start?

Atherosclerosis begins with the origin of

life

When the sperm penetrates the egg and we are a single fertilized cell, the genes and epigenetics of the mother,

father and family are present and their atherogenic risk

factors are contained in them.

What are risk factors of atherosclerosis in the 21st century?

Tobacco (smoke)

Carbon monoxide

Fast Food

Excessive alcohol

Sedentary lifestyle

TV Controls

Chips.

Excess Sugar and Salt

Occupational stress Family competition Job competition Wage dissatisfaction Family charge.

Conflicting neighbors Sick family.

How many of those risk factors could be present in

the VI Egyptian Dynasty 2670-2140 B.C.?

❖ Yater 1948 is recognized as a common coronary heart

disease in young people.

❖ CHD in young adults are not as well characterized as CHD in older because it occurs less frequently.

❖ This disease can have devastating consequences for young patients and their families.

❖ The differences in etiologies and risk profiles of younger

and older patients result in differences in disease

progression, prognosis, and treatment.

❖ Limited data suggest that prognosis may be better in the

young population.

Statistics corresponding to patients admitted with acute

coronary syndrome Institute of Cardiology.

Havana Cuba.

9

17

30 18

24

69

0

10

20

30

40

50

60

70

80

STE-MI NSTE-ACS

• To determine the clinical, electrocardiographic and anatomic-functional characteristics of young

adults with ACS

• To identify the most common reperfusion

strategies and complications in these patients

Hypothesis.

What are the clinical, electrocardiographic and anatomofunctional

characteristics of young adult with ACS?

What are the most common reperfusion strategies and complications in

these patients?

An observational cross sectional study.

99 patients were selected (a sample) that accomplished inclusion criteria from the 947 patients with a confirmed diagnosis of acute coronary syndrome who entered the institute between January 2013 and December 2014

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Figure 1 Types of presentation of acute coronary

syndrome per gender and age

0

20

40

60

80

30

69

N

N

STE-MI NSTE-ACS

Men 82.8% Age 41,9%

Figure 2 Risk factors in patients with acute coronary syndrome

Tobacco use Hypertension High bood Cholesterol

Personal History

Obesity Cancer

76,8 58,6 48,4 41,4 21,2

3

%

%

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Table 1 Types of presentation of acute coronary syndrome according to number of vessels affected

Number

of

arteries

Presentation

Total

Table 2 Types of presentation of acute coronary

syndrome according to the guildy artery of the event

Culpit

Artery

Presentation

Total

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Table 3 Left ventricle ejection fraction in patients with acute coronary syndrome according to the number of vessels affected

Number

of

arteries

IF

Total

Reperfusion treatment in acute coronary syndrome with ST segment elevation

16,6

30,0 26,6

3,3

23,3

%

Thrombolysis (5) Primary PCI (9) Rescue PCI (8) Surgery (1)

no (7)

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Reperfusion treatment in the acute coronary syndrome without elevation of the ST segment

21,7

27,5 14,5

36,2

%

Early PCI (15) Late PCI (19) CABGS (10)

No (25)

• The gender distribution in young adults with ACS is

similar to in older patients

• Most patients with ACS had cardiovascular risk factors

• The small extent of coronary artery disease justified: the preservation of ventricular function, after ischemic event and thus the low percentage of complications

• The PCI was the most widely used reperfusion strategy

in STE-MI, although there was under-utilization of this technique in NSTE-ACS

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• To implement early-life promotion and prevention activities, base on cardiovascular risk factors in order

to prevent the consequences and economic costs of CHD

• Screening CHD in young population may help to improve prognosis by detecting subclinical disease

• Additional researches must also focus on treatment concerns that are specific to young patients

Thank you for your kind attention

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