Acute coronary syndrome: the risk to young women

Background--although acute coronary syndrome (acs) mainly occurs in patients > 50 years,younger patients can be affected as well. we used an age cutoff of 45 years to investigate clinical characteristics and outcomes of young patients with acs. methods and results--between october 2010 and april 2016,14 931 patients with acs were enrolled in the isacs-tc (international survey of acute coronary syndromes in transitional countries) registry. of these patients,1182 (8%) were aged ≤45 years (mean age,40.3 years; 15.8% were women). the primary end point was 30-day all-cause mortality. percentage diameter stenosis of ≤50% was defined as insignificant coronary disease. st-segment-elevation myocardial infarction was the most common clinical manifestation of acs in the young cases (68% versus 59.6%). young patients had a higher incidence of insignificant coronary artery disease (11.4% versus 10.1%) and lesser extent of significant disease (single vessel,62.7% versus 46.6%). the incidence of 30-day death was 1.3% versus 6.9% for the young and older patients,respectively. after correction for baseline and clinical differences,age ≤45 years was a predictor of survival in men (odds ratio,0.24; 95% confidence interval,0.10-0.58),but not in women (odds ratio,1.35; 95% confidence interval,0.50-3.62). this pattern of reversed risk among sexes held true after multivariable correction for in-hospital medications and reperfusion therapy. moreover,younger women had worse outcomes than men of a similar age (odds ratio,6.03; 95% confidence interval,2.07-17.53). conclusion--acs at a young age is characterized by less severe coronary disease and high prevalence of st-segment-elevation myocardial infarction. women have higher mortality than men. young age is an independent predictor of lower 30-day mortality in men,but not in women. © 2017 the authors.