Acute coronary syndrome in patients younger than 30 years--aetiologies, baseline characteristics and long-term clinical outcome

Swiss Med Wkly. 2013 Jul 29:143:w13816. doi: 10.4414/smw.2013.13816. eCollection 2013.


Background: Coronary atherosclerosis begins early in life, but acute coronary syndromes in adults aged <30 years are exceptional. We aimed to investigate the rate of occurrence, clinical and angiographic characteristics, and long-term clinical outcome of acute coronary syndrome (ACS) in young patients who were referred to two Swiss hospitals.

Methods: From 1994 to 2010, data on all patients with ACS aged <30 years were retrospectively retrieved from our database and the patients were contacted by phone or physician's visit. Baseline, lesion and procedural characteristics, and clinical outcome were compared between patients in whom an underlying atypical aetiology was found (non-ATS group; ATS: atherosclerosis) and patients in whom no such aetiology was detected (ATS group). The clinical endpoint was freedom from any major adverse cardiac event (MACE) during follow-up.

Results: A total of 27 young patients with ACS aged <30 years were admitted during the study period. They accounted for 0.05% of all coronary angiograms performed. Mean patient age was 26.8 ± 3.5 years and 22 patients (81%) were men. Current smoking (81%) and dyslipidaemia (59%) were the most frequent risk factors. Typical chest pain (n = 23; 85%) and ST-segment elevation myocardial infarction (STEMI; n = 18 [67%]) were most often found. The ATS group consisted of 17 patients (63%) and the non-ATS group of 10 patients (37%). Hereditary thrombophilia was the most frequently encountered atypical aetiology (n = 4; 15%). At 5 years, mortality and MACE rate were 7% and 19%, respectively.

Conclusion: ACS in young patients is an uncommon condition with a variety of possible aetiologies and distinct risk factors. In-hospital and 5-year clinical outcome is satisfactory.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Coronary Syndrome / etiology*
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / therapy
  • Adult
  • Cocaine-Related Disorders / complications
  • Coronary Angiography
  • Coronary Artery Disease / complications*
  • Dyslipidemias / epidemiology
  • Endocarditis / complications
  • Familial Mediterranean Fever / complications
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Myocardial Infarction / etiology
  • Myocardial Infarction / mortality
  • Myocardial Infarction / therapy
  • Percutaneous Coronary Intervention
  • Retrospective Studies
  • Risk Factors
  • Smoking / epidemiology
  • Thrombophilia / complications*
  • Treatment Outcome
  • Young Adult

Supplementary concepts

  • Thrombophilia, hereditary