International Journal of Cardiology and Cardiovascular Research

IJCCR
Vol. 4(1), pp. 052-059, May, 2018. © www.premierpublishers.org, ISSN: 3102-9869

Research Article

Clinical Profile of Acute Coronary Syndrome among Young

Adults
*Vinod Kumar Balakrishnan1, Aashish Chopra2, Muralidharan T.R.3, Thanikachalam S4
1,2,3,4
Sri Ramachandra University, College in Chennai, India

Acute Coronary Syndrome accounts for 30% of hospital admissions with cardiovascular
diseases. The risk of this syndrome is increasing among the younger adults, and a deep insight
into the clinical profile among these patients will help in devising a preventive strategy, in order
to alleviate the morbidity and mortality due to the syndrome. A cross sectional study was done
among 125 subjects admitted to our tertiary care hospital with Acute Coronary Syndrome. Their
risk factors were assessed and a 12 Lead electrocardiogram and 2D Echocardiogram were taken.
Cardio III panel which consists of Troponin I, CK MB, BNP by COBAS meter machine was also
measured. STEMI was present in 73.6% of the patients, while unstable angina was present in 16%.
About 90% of STEMI patients were males and 62% of them were hypertensives. LV Ejection
Fraction <30% was found in 9% of STEMI patients. This study elucidates the need for a preventive
strategy for primordial prevention of cardiovascular events among young adults. The study
envisaged the male, urban preponderance towards these events.

Key words: Acute Coronary Syndrome, Left Ventricle Dysfunction, Ejection Fraction, Reperfusion, STEMI

INTRODUCTION

Worldwide, cardiovascular disease (CVD) is estimated to
be the leading cause of death and loss of Disability
Adjusted Life Years (DALY). The Global Burden of
Diseases (GBD) study reported the estimated mortality
from CVD in India at 1.6 million in the year 2000. It has
been predicted that by the year 2020 there will be an
increase by almost 75% in the global CVD burden (Murray
CJL,1997). The situation in India is more alarming.
Between 1990 and 2020, these diseases are expected to
increase by 120% for women and 137% for men in
developing countries. Furthermore, South Asians have a
high prevalence of risk factors, and have ischemic heart
disease at an earlier age than do people in developed
countries (Reddy KS, 1993).
fatality following acute coronary syndrome is considerably
higher among Indians as compared to other populations
(Prabakaran D, 2005). In addition, a reversal of socio-
economic gradients for CVD risk factors has emerged in
the Indian population (Reddy KS, 2007; Ajay S, 2008).
Several registries in India like CREATE Registry and
KERALA Registry emphasis on the impact of the disease
in the young and low socioeconomic group and also
highlight on reducing symptom-to-door time, door-to-
needle time, and inappropriate use of thrombolysis and
increasing use of recommended drugs.

Epidemiological studies from various parts of India have

reported the rising trends and a high burden in the levels
of conventional risk factors such as diabetes, hypertension
and metabolic syndrome which are largely determined by *Corresponding author: Vinod Kumar Balakrishnan, Sri
urbanization as evident from the urban-rural difference in Ramachandra University, College in Chennai, India. E-
the risk factors observed in India (Mohan V, 2007; Gupta mail: pamilastalin2004@gmail.com
R. 2004; Prabakaran D, 2007). Further, the long-term case

Clinical Profile of Acute Coronary Syndrome among Young Adults

Balakrishnan et al. 053
Acute coronary syndromes (ACS) account for about 30%
of hospital admissions of patients diagnosed with
cardiovascular diseases. The syndrome encompasses a
spectrum of events with different clinical severity based on
a partial or complete occlusion of the coronary artery. This
is predominantly due to thrombosis on a disrupted plaque •
in the vessel wall. The plaque, caused by an inflammatory •
process, stimulates the haemostatic CVD when the •
protective endothelial cells of the vessel wall are gone •
(Libby, 2001). Diagnosis of ACS is based on a group of
signs and symptoms of cardiac ischemia, an
electrocardiogram showing ST segment elevation or
depression or abnormalities of the T wave and a typical •
increase and decrease in biochemical markers of cardiac •
necrosis. Final diagnosis was classified as ACS- unstable •
angina or myocardial infarction (STEMI or NSTEMI) is
based on the level of cardiac markers as measured in •
blood (Antman, 2000; Eagle KA, 2004; Morrow DA, 2000).
Patients aged 40 years or less diagnosed as having ACS
had an unhealthy lifestyle. Cocaine use was frequent and
the prevalence of smoking, obesity, low HDL-cholesterol
and diabetes was higher. Although mortality during their
first hospital stay was low, the readmission rate was high
and readmission was associated with smoking and
decreased LVEF (Choudhury L, 1999).
The interaction between a genetic propensity to form
vulnerable plaque combined with acute stress and/or an
active infectious/inflammatory process needs further
study. If we can better identify and characterize the
mechanism of disease in this population, our
understanding of CVD in more typical cases will be vastly
improved.
OBJECTIVE
To study the clinical profile of Acute Coronary Syndrome
among young adults.
METHODOLOGY
Study Design
This study was carried out as a cross sectional study
Study Population
All patients who were admitted in our tertiary care hospital
with the diagnosis of Acute Coronary Syndrome were the
study population.
Study Period
August 2013 – January 2016
Sample Size and Sampling
Based on intensive literature review, it was observed that
ACS accounts for 30% of hospital admissions. At 95%
level of significance and 8% absolute precision, the final
Clinical Profile of Acute Coronary Syndrome among Young Adults
sample size was calculated as 126 and was rounded off to
125. The study participants were selected by consecutive
sampling.
Inclusion criteria
Age <40 years
Suspected ACS with ST and Non ST Elevated MI
Unstable angina with electrocardiographic changes
Exclusion criteria
History of any other cardiac illness,
Chronic inflammatory conditions like Systemic lupus
erythematosus, Rheumatoid arthritis or Multiple sclerosis.
Pregnancy
Ethical committee approval & Informed consent
Approval was obtained from the Institutional Ethics
Committee and informed consent was obtained from the
participants prior to data collection.
Data Collection
The data on age, sex, socio economic data, medical
history, baseline clinical characteristics, time to reach
hospital, time to needle time, time to balloon time, and
other forms of treatment during the stay of hospital was
obtained. Outcome at the time of discharge were
meticulously collected. Geographical area from which
patients came for treatment - urban, semi urban or rural
area, the type of transport utilized to reach the hospital and
how they met hospital cost for the treatment were also
recorded. A 12 Lead electrocardiogram was taken with
General Electrical machine in our hospital; 2D
Echocardiogram was taken with GE VIVID E 9. Cardio III
panel which consists of Troponin I, CK-MB, and BNP by
COBAS meter machine was also measured.
Statistical Analysis
Data was entered and analyzed using SPSS version 16.
RESULTS
A definitive diagnosis of either STEMI or NSTEMI or
Unstable angina (UA) was made. Out of 1184 patients who
was admitted with ACS in our centre, 125 patients (10.5%)
comes under young adult’s category. Among them,
92(73.6%) patients were STEMI, 13(10.4%) patients were
NSTEMI and 20(16%) patients were unstable angina. Sex-
wise incidence in this study showed that males were more
commonly affected. In view of obesity as the risk factor for
CVD, based on the BMI, 19.5% of the young patients had
a BMI higher than 30, whereas 47.5% were found to be
overweight. (Table 1)
 Int. J. Cardiol. Cardiovasc. Res. 054

Table 1: Demographic parameters of the study Table 2: Risk factors of ACS

participants
S/No Characteristics Frequency Percentage S/No Characteristics STEMI NSTEMI Unstable
(N=125) (%) (N=92) (N=13) angina
1 ACS Distribution n(%) n(%) (N=20)
STEMI 92 73.6 n(%)
NSTEMI 13 10.4 1 Gender
Unstable Angina 20 16 Male 83 (90.2) 9 (69.2) 12 (60)
2 Sex Female 9 (9.8) 4(31.8) 8 (40)
Male 104 83.2 2 Socioeconomic
Female 21 16.8 Area
3 Age (in years) Urban 63 (68.5) 11 (84.6) 14 (70)
18 – 25 8 6.4 Semi-urban 20 (21.7) 0 (0) 2 (10)
26 – 30 17 13.6 Rural 9 (9.8) 2 (15.4) 4 (20)
31 – 35 36 28.8 3 Smoking
36 – 40 64 51.2 Present 82(89.1) 1(7.7) 1(5)
4 Body Mass Index Absent 10(10.9) 12(92.3) 19(95)
Underweight 0 0 4 Hypertension
Normal 41 33 Present 57(61.9) 1(7.7) 5(25)
Overweight 60 47.5 Absent 35(38.1) 12(92.3) 15(75)
Obesity 24 19.5 5 Diabetes
Mellitus
In the present study, most common symptom was angina Present 63(68.5) 1(7.7) 5(25)
contributing to 97.50%(115cases) followed by dyspnea in Absent 29(31.5) 12(92.3) 15(75)
16.10% (19 cases), palpitations and nausea/vomiting in 6 Familial Hypercholesterolemia
6.80% (8 cases). (Figure1). It was observed that 90.2% of Present 66(71.7) 2(15.3) 2(10)
the participants with STEMI were males. Moreover, 68.5% Absent 26(28.3) 11(84.7) 18(90)
of STEMI belonged to urban areas. The prevalence of 7 Dyslipidemia
newly detected Hyperlipidemia was 58(46.4%) found to be Present 66 (71.7) 2 (15.3) 3(15)
higher followed by Diabetes. Overall, STEMI group had Absent 26(28.3) 11(84.7) 17(85)
high prevalence of risk factors and amongst them Smoking
was found to be high followed by Hyperlipidemia. (Table Among patients with ACS, 27 had evolved presentation
2). and 98 had acute presentation which comprises of both
NSTEMI and STEMI. It is not statistically significant.

LVEF Distribution, KILIP Score, MI Pattern with ACS

Majority of patients presented with Acute Coronary

Syndrome had preserved LV systolic function 69.6% (87)
and 15.2% (19) had mild LV systolic dysfunction followed
by moderate and severe LV systolic dysfunction of 8% and
7.2% respectively. All patients admitted with ACS – STEMI
(n=92) were analyzed and Anterior wall myocardial
infarction was found to be most common (59%), followed
by inferoposterior wall myocardial infarction (15.30%).
One case had involvement of myocardial infarction
involving anterior and inferior region. (Table 3)

Figure 1: Clinical symptoms of ACS

Clinical Profile of Acute Coronary Syndrome among Young Adults

Balakrishnan et al. 055

Table 2A

Table 3: LVEF Distribution, KILIP Score, MI Pattern

with ACS AWMI-anterior wall myocardial infarction, ALMI-
S/No Characteristics Frequency Percentage anterior and lateral wall myocardial infarction, IWMI-
(N=125) (%) inferior wall myocardial infarction, IPWMI- inferior and
1 LVEF Distribution posterior wall myocardial infarction, IPRWMI-inferior,
Normal 87 69.6 posterior and right ventricular myocardial infarction,
Mild 19 15.2 LWMI-lateral wall myocardial infarction, RVMI-right
Moderate 10 8 ventricular myocardial infarction, ILMI-inferior and
Severe 9 7.2 lateral wall myocardial infarction, True PWMI-True
2 KILIP SCORE posterior wall myocardial infarction.
1 104 83.2
2 5 4 In this study, 87 (70%) patients with Acute coronary
3 6 4.8 syndrome had preserved LV systolic function with greater
4 10 8 than 55%. A 19(15%) cases were between (40 –54)% and
3 MI Pattern (30 – 40) % were 10 (85) cases. 8(6.5%) patients were less
AWMI 54 59 than 30 %. In this study, 104 patients with Acute coronary
ALMI 6 6.5 syndrome had preserved KILLIP scores with 1 (Table 4).
IWMI 9 9.7
IPWMI 14 15.3
IPRWMI 5 5.9
LWMI 1 1.2
RVMI 1 1.2
ILMI 2 2.4
True PWMI 1 1.2

Clinical Profile of Acute Coronary Syndrome among Young Adults

 Int. J. Cardiol. Cardiovasc. Res. 056

Table 4: Types of ACS with LVEF and KILLIP scores. of the right coronary artery and 14% had involvement of
S/N Factors Type of ACS Total the left circumflex coronary artery, and 1% of case had
STEMI NSTEMI Unstable N(%) involvement of Left main disease which was seen on
N(%) N(%) Angina coronary angiography. In this study 11% of patients were
N(%) in cardiogenic shock and 8% cases had malignant
1 LVEF arrhythmia such as VT/VF. And out of total group of cases,
≥ 55% 57(62) 11(83) 20(100) 87(70) eleven of them had cardiac arrest and 4 cases were
40 -54% 18(19) 1(8) 0(0) 19(15) revived and are doing well. (Table 7)
30 to 40% 9(9) 1(8) 0(0) 10(8)
<30% 8(9) 0(0) 0(0) 8(6.5) Table 7: Vessel Involvement of the patients
2 KILIP Scores S/No Factors Frequency Percentage
1 72(78.3) 12(92.3) 20(100) 104(83.2)
N= 125 (%)
2 5(5.4) 0(0.0) 0(0.0) 5(4)
3 5(5.4) 1(7.7) 0(0.0) 6(4.8) 1 Vessel involvement
4 10(10.9) 0(0.0) 0(0.0) 10(8) Normal 7 5.9
Single vessel 84 71.2
In this study, patients with ACS reported with 45(36%) had Double vessel 13 11
a Medical management treatment. 5(4%) cases were Triple vessel 14 11.9
reported dead. (Table 5) 2 Vessel
characteristics
Table 5: Treatment Analysis of ACS LAD 85 56
LCX 22 14
S/N Treatment Frequency Percentage
RCA 43 28
(N=125) (%)
LM 2 1
1 Medical management 45 36
4 Complication
2 PCI 56 45
Cardiogenic shock 14 11
3 CABG 10 8
Arrhythmia 10 8
4 Advised PCI 8 6
VSR 0 0
5 Advised CABG 1 1
5 Cardiac Arrest
6 Death 5 4
Yes 11 9
No 114 91
REPERFUSION STRATEGY IN STEMI
DISCUSSION
In our study, out of 125 patients, the number of patients
who had STEMI was 92. primary percutaneous coronary
Coronary Artery disease is leading cause of death globally.
intervention was done in 16 patients,28 patients had
In 2001, coronary artery disease accounted for 7·1 million
evolved presentation,48 was thrombolysed (Tenecteplase-
deaths worldwide,15·7 million (80%) of which were in
18, Reteplase-9,&Streptokinase-21)and 23 patients had
under developed countries. Coronary artery disease is
recanalised coronary vessel by pharmacoinvasive
expected to increase by 120% for women and 137% for
strategy.
men in developing countries, compared with 30–60% in
developed countries. Furthermore, South Asians have a
Table 6: Reperfusion strategy in STEMI
high prevalence of risk factors, and have coronary artery
S/No Reperfusion strategy Frequency Percentage
disease at an earlier age than in developed countries.
(N=125) (%)
1 Total STEMI 92 73.6
2 Evolved STEMI 28 30 Acute coronary syndromes (ACS) comprises for about
3 Primary PCI 16 17 thirty percent of admissions of patient diagnosed with
4 Tenectaplase 18 38 cardiovascular diseases and about a third of the patients
5 Reteplase 9 19 in this population have mortality due to an ACS event.
6 Streptokinase 21 44 Acute coronary syndrome is spectrum of events with
7 Recanalised vessel by 23 48 different clinical severity based on extent of occlusion of
Pharmacoinvasive strategy the coronary artery and is predominantly due to thrombosis
on a ruptured plaque in the vessel wall. This ruptured
A majority of the patients (71.2%) had single vessel plaque, caused by an inflammatory process, activates the
disease which was seen on coronary angiography, hemostatic cascade due to release of tissue factor
followed by 11.9% had triple vessel disease, 11% had released from debris of ruptured plaque which attract
double vessel disease and 5.9% of patients had normal thrombus.
coronaries. About 56% of the patients had involvement of
the left anterior descending artery, 28% had involvement

Clinical Profile of Acute Coronary Syndrome among Young Adults

Balakrishnan et al. 057
This study is aimed to do A Clinical profile of Acute
coronary syndrome in young adults. The subsequent
patients who were admitted through Emergency room or
cross reference which are taken up for this study in a
tertiary care setup. We enrolled125 young adults below 40
years and above 18 years during study period of 30months
with an objective to find out occurrence of various type of
acute coronary syndrome as an In Hospital registry and
also do a multivariate analysis of clinical features, risk
factors, clinical presentation and laboratory data including
bio markers, occurrence of cardiogenic shock, Acute LV
failure, sudden onset of mitral regurgitation, ventricular
septal rupture are looked and documented. Incidence of
Acute coronary syndrome below 40 years in Thai Registry
was 5.8% but in our present study it was found to be 6.5%
subjects.
Myocardial Infarction when it occurs in young individuals
especially carries a significant morbidity, psychological
effects, and economic burden to the person and the family.
In our present study majority of patients presented with
mean age of 34.6 and there is clear preponderance of male
subjects 83.2% than female subjects. In addition, ST
elevation myocardial infarction occurred in 74% of
incidence. These observations are in agreement with
CREATE registry first of its tempo in India comparing of
patients in Tamil Nadu state with Acute coronary syndrome
ensured about 60% of patients presented with STEMI a
major group of acute coronary syndrome. In contrast with
developed countries indicates same as less than 40%
patient with Acute coronary syndrome had STEMI.
Similar findings were observed in a study (Sricharan KN,
2012) on Acute Myocardial Infarction in Young Adults
wherein 70% of patients were within the age group of 35-
40 years and 90% were males. Another study (Goornavar
S M et.al., 2011) in Karnataka found that half proportion of
cases were in36-40 years age group and 94.7% were
males.
This emphasizes that patient is more likely to have disease
early in life and develop myocardial infarction in younger
age without much collaterals due to short duration of
disease at that point of age resulting in involvement of
large myocardial area and make prognosis worse.
The association of Obesity, Diabetes Mellitus, Systemic
Hypertension, Dyslipidemia and Smoking are all validated
risk factor related to coronary artery disease. In present
study people who had disease less than 40 years of age
found to have two or more risk factors. This observation
emphasizes a primordial prevention strategy at population
level by bringing down all risk factors to target level.
The present study indicated that 90% of them were
smokers. The other risk factor Diabetes Mellitus was
observed in 31% of patients. Many studies at population
level showed that there is increasing incidence of Diabetes
Clinical Profile of Acute Coronary Syndrome among Young Adults
mellitus apart from occurrence of diabetes mellitus in
young age as low as 18 years. Further pre-diabetic status
has been considered as precursor for Acute Coronary
Syndrome and establish Coronary Artery Disease which is
considered as synonym of Diabetes Mellitus. Similar
finding was noted in Oman study for Acute coronary
syndrome which found that diabetes mellitus was noted in
28% of cases. It was quite obvious to see overweight in
form of Obesity is seen in 47% of case. Dyslipidemia was
found to be another significant risk factor comprising of
47% of patients which is precursor for atherosclerotic
coronary artery disease. Comparing to other study it was
found prevalence of systemic hypertension 26% and
dyslipidemia 20% (Tamrakar R, 2013; Kanitz MG 1993).
The association of cluster of risk factors in age group less
than 40 years made age vulnerable to acute coronary
syndrome. The clinical presentation of acute coronary
syndrome with chest pain being common and Anterior wall
MI on ECG which was found in 59% of cases whereas
single vessel disease – Left anterior descending artery on
angiography was seen in 71.2%. Similar findings were
observed in various studies. (Sricharan K.N 2012;
Goornavar SM 2011; TamrakarR, 2013).
In STEMI group total recanalization of vessel by
pharmacoinvase therapy was found to be of 48% of cases.
Cardiogenic shock occurred in 11% of study group and
3.6% cases were recovered by revascularization therapy
through percutaneous coronary intervention but rest had
malignant arrhythmia which lead to instability of subject
and leading to prolonged cardiopulmonary resuscitation
but could not be revived which lead to mortality. In hospital
mortality in this study was 6% of cases and they were in
cardiogenic shock status, malignant arrhythmia or
pulseless electrical activity noted.
Unlike West, majority of the patients in our part of the world
are not covered with health insurance, the people who
underwent primary PCI were meagre.
CONCLUSION
Present study revealed Acute Coronary Syndrome in age
group below 40years with preponderance towards males.
People from urban area seem to be vulnerable through this
atherosclerotic tendency. There is high prevalence of
dominant risk factors which has been validated globally.
This study uncovers the reason for premature
atherosclerotic heart disease below 40 years of age in both
male and female without associated high family history is
the association with unfavorable environmental influence
which triggered various risk factor associations. Further
study emphasizes the need for primordial prevention to
evolve interventional methods by public education at
school & college level, general public awareness creation
about young age acute coronary events.

SUMMARY
Acute coronary syndromes are a major cause of concern
in the present-day world particularly when it happens in a
younger age group population. It poses a huge economic
burden to the society also with loss of life at a productive
age group. Though the technologies have emerged to
combat the situation by various newer revascularization
techniques which are becoming available more and more
in various parts of the world the main crux should be on
preventive strategies which are possible only by
dissemination of health education on all possible means by
lifestyle modification, early identification and modification
of risk factors. This study particularly exposes the
ramifications on various modalities in the presentation of 1.
acute coronary syndromes in younger population which
paves way for further larger studies and will help health
policy makers to plan proper mean to achieve the goal of
reducing cardiovascular mortality on the whole especially
in younger population.
LIMITATIONS OF THIS STUDY
Firstly, not all the risk factors for AMI, which were reported
in the INTERHEART study, were assessed. These factors
included lack of physical activity, dietary factors,
psychosocial habits, psychiatric illness such as
depression, and alcohol consumption (Yusuf S, 2004).
However, in a more recent analysis of the INTERHEART
data, the addition of these risk factors did not show to
improve score discrimination in an external cohort
(McGorrian C, 2011). The current study did, however,
include all the risk factors used to calculate the
INTERHEART modifiable risk score, which was
subsequently proposed for the estimation of CHD risk in
multiple regions of the world. Secondly this study was
conducted in a single center.
Despite the recent decline in mortality from coronary heart
disease (CHD), this disease remains the leading killer
globally of all ages. CHD in young adults is not as well
characterized as CHD in older individuals because it
occurs less frequently, but this disease can have
devastating consequences for young patients and their
families. As in older adults, the majority of coronary events
in young adults are related to atherosclerosis, and one or
more of the traditional CHD risk factors is typically present.
Young patients, however, are more likely than older
patients to be smokers, male, obese, and to have a
positive family history. Risk factor reduction is thus of major
importance in managing young CHD patients.
Approximately 20% of CHD in young adults, however, is
related to non-atherosclerotic factors, such as coronary
abnormalities, connective tissue disorders, and
autoimmune diseases. Cocaine and other illicit drug use
have been increasingly associated with acute myocardial
infarction and accelerated atherosclerosis. The differences
Clinical Profile of Acute Coronary Syndrome among Young Adults
Int. J. Cardiol. Cardiovasc. Res. 058
in etiologies and risk profiles of younger and older CHD
patients result in differences in disease progression,
prognosis, and treatment. Limited data suggest that
prognosis may be better in the young population, although
long-term mortality studies have suggested otherwise.
Screening for CHD in the young population may help to
improve prognosis in young patients by detecting
subclinical disease, although more studies are necessary
to establish reference limits for this young population.
Additional research must also focus on treatment concerns
that are specific to young patients.
REFERENCES
Ajay VS, Prabhakaran D, Jeemon P, Thankappan KR,
Mohan. V, Ramakrishnan L, et al. Prevalence and
determinants of diabetes mellitus in the Indian Industrial
population. Diabetic Med 2008; 25 : 1187-94.
Antman EM, Cohen M, Bernink PJ, et al. The TIMI risk
score for unstable angina/non-ST elevation MI: a
method for prognostication and therapeutic decision
making. JAMA 2000;284:835– 42.
Choudhury L, Marsh JD. Myocardial infarction in young
patients. Am J Med 1999; 107: 254-61
Eagle KA, Lim MJ, Dabbous OH, et al. A validated
prediction model for all forms of acute coronary
syndrome: estimating the risk of 6-month post
discharge death in an international registry. JAMA
2004;291:2727–333.
Goornavar. S.M. MD ,Dr.Pramiladevi.R. MD, Dr.
Biradar.Satish.B. MD , Dr. Malaji Sangamesh MD , Dr.
Kora .S.A. MD, Dr.Narayan.M MS. Acute myocardial
infarction in young. JPBMS, 2011, 8 (16):1-5 Indian
Journal of Basic and Applied Medical Research , March
2015: Vol.-4, Issue- 2, P. 510-515
Gupta R. Trends in hypertension epidemiology in India.
11. J Hum Hypertens 2004; 18 : 73-8
Kanitz MG, Giovannucci SJ , Jones JS, Mott M. Myocardial
infarction in young adults; risk factors and clinical
features. J Emerge Med 1996 Mar- Apr; 14(2):139-45.
Libby P. Current concepts of the pathogenesis of the acute
coronary syndromes. Circulation 2001;104:365-372
McGorrian C, Yusuf S, Islan S, Jung H, Rangarajan S, et
al. (2011) on behalf of the INTERHEART Investigators.
Estimating modifiable coronary heart disease risk in
multiple regions of the world: the INTERHEART
Modifiable Risk Score. European Heart Journal 32:
581-589.
Mohan V, Sandeep S, Deepa R, Shah B, Varghese C.
Epidemiology of type 2 diabetes: Indian scenario.
Indian J Med Res 2007; 125 : 217-30.
Morrow DA, Antman EM, Charlesworth A, et al. TIMI risk
score for ST-elevation myocardial infarction: a
convenient, bedside, clinical score for risk assessment
at presentation: an intravenous nPA for treatment of
infarcting myocardium early II trial sub-study.
Circulation 2000;102:2031–7
Balakrishnan et al. 059

Murray CJL, Lopez AD. Mortality by cause for eight regions Yusuf S, Hawken S, Ounpuu, Dans T, Avezum A, Lanas
of the world: Global Burden of Disease Study. Lancet F, et al. (2004) on behalf of the INTERHEART Study
1997; 349: 1269-1276\ Investigators. Lancet 364: 937-952.
Prabhakaran D, Chaturvedi V, Shah P, Manhapra A,
Jeemon . P, Shah B, et al. Differences in the prevalence
of metabolic syndrome in urban and rural India: a
problem of urbanization. Chronic Illness 2007; 3 : 8-19.
Prabhakaran D, Yusuf S, Mehta S, Pogue J, Avezum A,
Budaj . A, et al. Two-year outcomes in patients admitted
with non- ST elevation acute coronary syndrome:
results of the OASIS registry 1 and 2. Indian Heart J
2005; 57 : 217-25. Accepted 21 March 2018
Reddy KS, Prabhakaran D, Jeemon P, Thankappan KR,
Joshi 14. P, Chaturvedi V, et al. Educational status and Citation: Balakrishnan V.K., Chopra A., Muralidharan
cardiovascular risk profile in Indians. ProcNatlACVDSci T.R., Thanikachalam S. (2018). Clinical Profile of Acute
USA 2007; 104 : 16263-8. Coronary Syndrome among Young Adults. International
Reddy KS. Cardiovascular diseases in India. World Health Journal of Cardiology and Cardiovascular Research, 4(1):
Stat Q 1993; 46: 101-107. 052-059.
Sricharan K.N., Rajesh S., Rashmi, Meghana H.C.,
Sanjeev Badiger, Soumya Mathew. Study of Acute
Myocardial Infarction in Young Adults: Risk Factors,
Presentation and Angiographic Findings. Journal of
Clinical and Diagnostic Research. 2012 April, Vol-6(2): Copyright: © 2018 Balakrishnan et al. This is an open-
access article distributed under the terms of the Creative
257-260.
Commons Attribution License, which permits unrestricted
Tamrakar R, Bhatt YD, Kansakar S, et al. Acute Myocardial
use, distribution, and reproduction in any medium,
Infarction in Young Adults:Study of Risk factors,
provided the original author and source are cited.
Angiographic Features and Clinical Outcome. Nepalese
Heart Journal 2013;10(1):12-16.

Clinical Profile of Acute Coronary Syndrome among Young Adults