40 Yaş ve Altı Akut Koroner Sendrom Hastalarında Risk Faktörleri

Year 2026, Volume: 16 Issue: 1, 25 - 31, 23.01.2026

Aydın Dursun , Mehmet Cem Başel , Nurullah Ay , Hakan Guven , Ali Erol , Mustafa Boğan

Abstract

Amaç: Bu çalışmada akut koroner sendromlu (AKS) genç erişkin hastaların (<40 yaş) klinik ve demografik özelliklerini ve risk faktörlerini analiz etmeyi amaçladık. Uygulanan tedavi yöntemleri ile cinsiyet faktörünün klinik farklılıkları ve sonuçları.
Gereç ve Yöntemler: Bu retrospektif çalışmaya 2016-2020 yılları arasında Bursa şehrindeki bir hastanede akut koroner sendrom nedeniyle tedavi edilen 40 yaş ve altındaki hastalar dahil edildi.
Bulgular: Çalışmaya toplam 63 hasta (%7,4) dâhil edildi. Hastaların çoğunluğu erkekti (%78) ve ortanca yaş 38 idi. Sigara kullanımı erkeklerde kadınlara göre anlamlı derecede daha yaygındı (%97,9'a karşı %42,8, p<0.001). Erkeklerde kreatinin (0,81±0,13 vs. 0,69±0,08 mg/dL, p=0,010) ve hemoglobin düzeyleri (15±1,3 vs. 11,7±1,6 g/dL, p<0,001) daha yüksekken, kadınlarda RDW (%14 vs. %13, p=0,020) ve trombosit sayıları (350±82 vs. 282±63 ×10³/µL, p=0,010) daha yüksekti. Hiperlipidemi stent grubunda (%72) KABG (%41,2) ve medikal gruplara (%10) kıyasla daha sıktı (p=0.006). Kararsız anjina KABG hastalarında (%58,9) ve STEMI stent hastalarında (%52,9) daha yaygındı (p=0,005 ve p=0,040). Glukoz ve troponin düzeyleri sırasıyla medikal ve stent gruplarında daha yüksekti (her ikisi için de p=0,020). HDL medikal grupta daha yüksekti (46±4 mg/dL, p=0.020).
Sonuç: Bu çalışmada tanımlanan risk faktörleri ve biyokimyasal parametrelerdeki cinsiyet ve tedaviye bağlı farklılıklar, koroner arter hastalığında bireyselleştirilmiş risk değerlendirmesini destekleyebilir. Özellikle, erkeklerdeki yüksek sigara içme oranları ve kadınlardaki farklı hematolojik özellikler klinik değerlendirmede dikkate alınmalıdır.

Keywords

Akut koroner sendrom , Akut koroner sendrom , genç erişkin , cinsiyet faktörü , risk faktörleri

Ethical Statement

Çalışma için yerel etik kurulundan onay alınmıştır (Tarih: 03.09.2024, Karar no: 2024-04).

The Risk Factors in Patients 40 Years and Under with Acute Coronary Syndrome

Abstract

Aim: In this study, we aimed to analyze the clinical and demographic characteristics and risk factors of young adult patients (aged <40 years) with acute coronary syndrome (ACS). Clinical differences and outcomes related to the sex factor with the treatment modalities applied.
Material and Methods: This retrospective study included patients aged 40 years and younger who were treated for acute coronary syndrome in a hospital in Bursa between 2016 and 2020.
Results: A total of 63 patients (7.4%) were included in the study. The majority of the patients were male (78%) and the median age was 38 years. Smoking was significantly more common in males than females (97.9% vs. 42.8%, p<0.001). Males had higher creatinine (0.81±0.13 vs. 0.69±0.08 mg/dL, p=0.010) and hemoglobin levels (15±1.3 vs. 11.7±1.6 g/dL, p<0.001), while females had higher RDW (14% vs. 13%, p=0.020) and platelet counts (350±82 vs. 282±63 ×10³/µL, p=0.010). Hyperlipidemia was more frequent in the stent group (72%) compared to CABG (41.2%) and medical groups (10%) (p=0.006). Unstable angina was more common in CABG patients (58.9%), and STEMI in patients with stents (52.9%) (p=0.005 and p=0.040). Glucose and troponin levels were higher in the medical and stent groups, respectively (p=0.020 for both). HDL was higher in the medical group (46±4 mg/dL, p=0.020).
Conclusion: The gender- and treatment-related differences in risk factors and biochemical parameters identified in this study may support individualized risk assessment in coronary artery disease. Notably, high smoking rates in males and distinct hematologic features in females merit attention in clinical evaluation.

Keywords

Acute coronary syndrome , Acute coronary syndrome , young adult , sex factors , risk factors

Ethical Statement

Approval for the study was obtained from the local ethics committee (Date: 03.09.2024, Decision no: 2024-04).

References

• 1. Martin SS, Aday AW, Almarzooq ZI, Anderson CA, Arora P, Avery CL, et al. 2024 heart disease and stroke statistics: a report of US and global data from the American Heart Association. Circulation. 2024; 149(8): e347-e913 doi:10.1161/CIR.0000000000001209.
• 2. Dugani SB, Hydoub YM, Ayala AP, Reka R, Nayfeh T, Ding JF, et al. Risk factors for premature myocardial infarction: a systematic review and meta-analysis of 77 studies. Mayo Clin Proc Innov Qual Outcomes. 2021; 5(4):783-94. doi:10.1016/j.mayocpiqo.2021.03.009.
• 3. Cole JH, Miller JI, Sperling LS, Weintraub WS. Long-term follow-up of coronary artery disease presenting in young adults. J Am Coll Cardiol. 2003; 41(4):521-8. doi:10.1016/s0735-1097(02)02862-0.
• 4. Agrawal A, Lamichhane P, Eghbali M, Xavier R, Cook DE, Elsherbiny RM, et al. Risk factors, lab parameters, angiographic characteristics and outcomes of coronary artery disease in young South Asian patients: a systematic review. J Int Med Res. 2023; 51(8):03000605231187806. doi:10.1177/03000605231187806.
• 5. Maroszynska-Dmoch EM, Wozakowska-Kaplon B. Clinical and angiographic characteristics of coronary artery disease in young adults: a single centre study. Kardiol Pol. 2016; 74(4):314-21. doi:10.5603/KP.a2015.0178
• 6. Bhardwaj R, Kandoria A, Sharma R. Myocardial infarction in young adults-risk factors and pattern of coronary artery involvement. Niger Med J. 2014; 55(1):44-7. doi:10.4103/0300-1652.128161.
• 7. Shrateh ON, Al-Tawil M, Awad A, Zeer ZMM, Owais TA, Sinokrot A, et al. Acute coronary syndrome in young (≤45 years) patients: a multi-centre observational study. Ann Med Surg (Lond). 2024; 86(6):3303-9. doi:10.1097/MS9.0000000000002125.
• 8. Sarr M, Ba DM, Ndiaye MB, Bodian M, Jobe M, Kane A, et al. Acute coronary syndrome in young Sub-Saharan Africans: a prospective study of 21 cases. BMC Cardiovasc Disord. 2013; 13:118. doi:10.1186/1471-2261-13-118.
• 9. Sawada H, Ando H, Takashima H, Waseda K, Shimoda M, Ohashi H, et al. Epidemiological features and clinical presentations of acute coronary syndrome in young patients. Intern Med. 2020; 59(9):1125-31. doi:10.2169/internalmedicine.4138-19.
• 10. Rojas-Velázquez JM, Giralt-Herrera A, Torre Fonseca LM, Machín-Legón M, Cordero Menéndez SS. Gender differences in acute coronary syndrome. Clin Investig Arterioscler. 2020; 32(2):43-8. doi:10.1016/j.arteri.2019.08.001.
• 11. Hao Y, Liu J, Liu J, Yang N, Smith SC Jr, Huo Y, et al. Sex differences in in-hospital management and outcomes of patients with acute coronary syndrome. Circulation. 2019; 139(15):1776-85. doi:10.1161/CIRCULATIONAHA.118.037655.
• 12. Haider A, Bengs S, Luu J, Osto E, Siller-Matula JM, Muka T, et al. Sex and gender in cardiovascular medicine: presentation and outcomes of acute coronary syndrome. Eur Heart J. 2020; 41(13):1328-36. doi:10.1093/eurheartj/ehz898.
• 13. Brown RM. Acute coronary syndrome in women. Emerg Med Clin North Am. 2022; 40(4):629-36. doi:10.1016/j.emc.2022.06.003.
• 14. Horn P, Haschemi J, Kelm M. The role of gender in revascularization strategies for acute coronary syndrome and multivessel disease. Am J Cardiol. 2024; 217:153-5. doi:10.1016/j.amjcard.2024.02.008.
• 15. Teixeira M, Sá I, Mendes JS, Martins L. Acute coronary syndrome in young adults. Rev Port Cardiol. 2010; 29(6):947-55.
• 16. Tong KL, Zuhdi AS, Ahmad WA, Vanhoutte PM, de Magalhaes JP, Mustafa MR, et al. Circulating microRNAs in young patients with acute coronary syndrome. Int J Mol Sci. 2018; 19(5):1467. doi:10.3390/ijms19051467.
• 17. Pellaton C, Monney P, Ludman AJ, Schwitter J, Eeckhout E, Hugli O, et al. Clinical features of myocardial infarction and myocarditis in young adults: a retrospective study. BMJ Open. 2012; 2(6): e001571. doi:10.1136/bmjopen-2012-001571.
• 18. Elscot JJ, Kakar H, Dekker WKD, Bennett J, Sabaté M, Esposito G, et al. Complete revascularization strategies in women and men with acute coronary syndrome and multivessel disease. Am J Cardiol. 2024; 214:25-32. doi:10.1016/j.amjcard.2023.
• 19. Affandi S, O'Nunain S. Investigations and management strategies of acute myocardial infarction in young adults (a single centre clinical audit). Clin Med (Lond). 2020; 20(Suppl 2):s1. doi:10.7861/clinmed.20-2-s1.
• 20. Groothof D, Shehab NBN, Erler NS, Post A, Kremer D, Polinder-Bos HA, et al. Creatinine, cystatin C, muscle mass, and mortality: findings from a primary and replication population-based cohort. J Cachexia Sarcopenia Muscle. 2024; 15(4):1528-38. doi:10.1002/jcsm.13511.
• 21. Korniluk A, Koper-Lenkiewicz OM, Kamińska J, Kemona H, Dymicka-Piekarska V. Mean Platelet Volume (MPV): new perspectives for an old marker in the course and prognosis of inflammatory conditions. Mediators Inflamm. 2019; 2019:9213074. doi:10.1155/2019/9213074.
• 22. Salvagno GL, Sanchis-Gomar F, Picanza A, Lippi G. Red blood cell distribution width: a simple parameter with multiple clinical applications. Crit Rev Clin Lab Sci. 2015; 52(2):86-105. doi:10.3109/10408363.2014.992064.
• 23. Lippi G, Turcato G, Cervellin G, Sanchis-Gomar F. Red blood cell distribution width in heart failure: a narrative review. World J Cardiol. 2018; 10(2):6-14. doi:10.4330/wjc.v10.i2.6.
• 24. Mueller C, Giannitsis E, Christ M, Ordóñez-Llanos J, deFilippi C, McCord J, et al. Multicenter evaluation of a 0-hour/1-hour algorithm in the diagnosis of myocardial infarction with high-sensitivity cardiac troponin T. Ann Emerg Med. 2016; 68(1):76-87.e4. doi:10.1016/j.annemergmed.2015.11.013.
• 25. Vernooij LM, van Klei WA, Moons KG, Takada T, van Waes J, Damen JA. The comparative and added prognostic value of biomarkers to the Revised Cardiac Risk Index for preoperative prediction of major adverse cardiac events and all-cause mortality in patients who undergo noncardiac surgery. Cochrane Database Syst Rev. 2021; 12(12):CD013139. doi:10.1002/14651858.CD013139.pub2.
• 26. McLaughlin T, Reaven G, Abbasi F, Lamendola C, Saad M, Waters D, et al. Is there a simple way to identify insulin-resistant individuals at increased risk of cardiovascular disease? Am J Cardiol. 2005; 96(3):399-404. doi:10.1016/j.amjcard.2005.03.085.
• 27. Feng TY, Chen C, Sun G, Zheng T. The nonlineard association between triglyceride to HDL cholesterol ratio and long-term heart disease risk: findings from China Health and Retirement Longitudinal Study (CHARLS). BMC Cardiovasc Disord. 2024; 24(1):639. doi:10.1186/s12872-024-04308-w.