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Relation of Sudden cardiac arrest with coronary artery disease in young adults

 Waldmann1, W. Bougouin1, N. Karam1, F. Dumas2, A. Sharifzadehgan1, K. Narayanan3,et al. European Heart Journal ( 2018 ) 39 ( Supplement ), 61

Background: Considering major shifts in coronary artery disease (CAD) epidemiology over the last two decades, with substantial changes in cardiovascular risk factor profile and earlier manifestation, it was hypothesized that CAD was likely the main etiology of sudden cardiac arrest (SCA) among young adults at present.

Aim: To describe burden and features of CAD related SCA in young (≤40 year old) adults using a contemporary community based study.

Methods: From May 2011 to 2016, all cases of SCA admitted alive across 48 hospitals in a defined geographical area were prospectively enrolled. Cardiovascular causes of SCA were determined from medical records by central adjudication.

Results: Out of 18,662 out of hospital cardiac arrests, 3,028 SCA were admitted alive, with 353 (11.7%) being ≤40 year old (32.1±6.2 years; 70.8% males). Overall, among the 1,557 (51.4%) patients with an established cardiac cause, 142 (9.1%) were younger than 40years and CAD accounted for 58 cases (40.8%), whereas non-ischemic

structural heart disease and non-structural heart disease for 52 (36.6%) and 32 (22.5%), respectively. Proportion of SCA due to CAD was 14.9%, 53.7% and 83.2% respectively in the <30, 30–40 and >40 years age groups. Within CAD related SCA, acute coronary syndromes were more frequent in younger patients (100.0% <30 years, 84.3% 30 to 40 years and 75.9% >40years, p<0.001), compared to chronic ischemic heart disease (without acute culprit lesion). Young CAD patients had more cardiovascular risk factors (≥1) than young non CAD patients (82.1% vs. 50.6%, p<0.001), especially current smoking (58.9% vs. 28.9%, p<0.001) and dyslipidemia (16.4% vs. 1.2%, p=0.001). However, they were less likely to have prior known heart disease (10.9%), compared to young non CAD patients (40.5%, p<0.001) or older CAD related cases (36.7%, p<0.001). Young CAD patients also had a different distribution of risk factors compared to older CAD cases, with a higher prevalence of active smoking (58.9% vs. 42.5%, p=0.02) and a lower prevalence of other risk factors. While 86.2% of CAD related SCA cases before 40 were due to an acute

coronary syndrome, rate of immediate coronary angiography at hospital admission was only 39.2% compared to 63.4% in >40years (OR=0.38, 95% CI: 0.27–0.53, p<0.01).

Conclusions: CAD (especially acute coronary syndrome) is a major cause of SCA in young adults, with abround >50% of SCAs occurring in the third decade, often as an inaugural event. Low rates of early angiography, and a distinct risk factor profile highlight the need for improved awareness among clinicians and patients as well as targeted research to better identify determinants of early CAD.

 

Source: ESC 2018 Last Modified :Aug 6, 2019.
Compiled and edited by the Editorial team and approved by Expert panel of CardioValens.com
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