Profile of acute coronary syndrome in young diabetics: a review
Keywords:Acute coronary syndrome, Coronary angiography, Coronary artery disease, Diabetes mellitus
The clinical presentation and angiographic findings of coronary artery disease (CAD) varies from diabetic and non-diabetic patients and varies with the age of presentation. Coronary artery disease in patients below the age of 45 is a special subset. The objective of this study is to compare the clinical and angiographic profile in patients with the acute coronary syndrome (ACS) with diabetes mellitus (DM) and without DM below the age of 45 years. Clinical Presentation of coronary artery disease in young patients with various risk factors differs, which plays an important role in management strategies. This was conducted through internet search on PubMed and ProQuest database from 2000 to until 2019. Key words used for searching are acute coronary syndrome, young diabetics, and clinical, angiographic profile. An important exclusion criterion is studies which included type one diabetic patients. Totally 35 papers were reviewed. Pattern of involvement of coronary arteries as assessed by the coronary angiographic study is found to be different in younger CAD patients. Atypical clinical presentation and distinct angiographic finding are common in diabetics below the age of 45. In most of the studies single vessel disease (SVD) is the most common angiographic finding in young CAD and non-diabetics. While the diabetics showed the more diffuse pattern of double vessel disease (DVD).
Tungsubutra W, Tresukosol D, Buddhari W, Boonsom W, Sanguanwang S, et al. Acute coronary syndrome in young adults: The Thai ACS Registry. J Med Assoc Thail Chotmaihet Thangphaet. 2007 Oct 1;90 Suppl 1:81-90.
Sinha SK, Krishna V, Thakur R, Kumar A, Mishra V, Jha MJ, et al. Acute myocardial infarction in very young adults: A clinical presentation, risk factors, hospital outcome index, and their angiographic characteristics in North India-AMIYA Study. ARYA Atheroscler. 2017 Mar;13(2):79-87.
Rivera JJ, Nasir K, Cox PR, Choi E-K, Yoon Y, Cho I, et al. Association of traditional cardiovascular risk factors with coronary plaque sub-types assessed by 64-slice computed tomography angiography in a large cohort of asymptomatic subjects. Atheroscler. 2009 Oct 1;206(2):451-7.
Nagamalesh UM, Abhinay T, Naidu KK, Ambujam N, Hegde AV, Prakash VS. Clinical profile of young Indian women presenting with acute coronary syndrome. J Clini Prevent Cardiol. 2018;7(3):106.
Iragavarapu T, Radhakrishna T, Babu KJ, Sanghamitra R. Acute coronary syndrome in young-A tertiary care centre experience with reference to coronary angiogram. J Pract Cardiovas Sci. 2019 Jan 1;5(1):18.
Fabian B, Nina D, Michael DS, Sujith KS, Ferencik Maros, Javed B, et al. Association Between Cardiovascular Risk Profiles and the Presence and Extent of Different Types of Coronary Atherosclerotic Plaque as Detected by Multidetector Computed Tomography. Arterioscler Thromb Vasc Biol. 2008 Mar 1;28(3):568-74.
Kumar A, Kaur H, Devi P. Coronary artery disease in women: How does it differ from men. J Indian Acad Clini Med. 2011;13(1):43-7.
Sunman H, Yorgun H, Canpolat U, Hazırolan T, Kaya EB, Ateş AH, et al. Association between family history of premature coronary artery disease and coronary atherosclerotic plaques shown by multidetector computed tomography coronary angiography. Int J Cardiol. 2013;164(3):355-8.
Starkman HS, Cable G, Hala V, Hecht H, Donnelly CM. Delineation of Prevalence and Risk Factors for Early Coronary Artery Disease by Electron Beam Computed Tomography in Young Adults With Type 1 Diabetes. Diab Care. 2003 Feb 1;26(2):433-6.
Otaki Y, Gransar H, Cheng VY, Dey D, Labounty T, Lin FY, et al. Gender differences in the prevalence, severity, and composition of coronary artery disease in the young: a study of 1635 individuals undergoing coronary CT angiography from the prospective, multinational confirm registry. Eur Heart J - Cardiovasc Imaging. 2015 May 1;16(5):490-9.
Raj KB, Sivachandran G. A study on clinical profile of acute coronary syndrome in type 2 diabetes mellitus patients with relevance to HbA1c.
Shah N, Kelly AM, Cox N, Wong C, Soon K. Myocardial Infarction in the “Young”: Risk Factors, Presentation, Management and Prognosis. Heart Lung Circ. 2016 Oct;25(10):955-60.
Aggarwal A, Srivastava S, Velmurugan M. Newer perspectives of coronary artery disease in young. World J Cardiol. 2016 Dec 26;8(12):728-34.
Christus T, Shukkur AM, Rashdan I, Koshy T, Alanbaei M, Zubaid M, et al. Coronary Artery Disease in Patients Aged 35 or less - A Different Beast? Heart Views. 2011;12(1):7-11.
Sekhri T, Kanwar RS, Wilfred R, Chugh P, Chhillar M, Aggarwal R, et al. Prevalence of risk factors for coronary artery disease in an urban Indian population. BMJ Open. 2014 Dec 1;4(12):e005346.
Vikulova DN, Grubisic M, Zhao Y, Lynch K, Humphries KH, Pimstone SN, Brunham LR. Premature Atherosclerotic Cardiovascular Disease: Trends in Incidence, Risk Factors, and Sex‐Related Differences, 2000 to 2016. J Am Heart Assoc. 2019 Jul 16;8(14):e012178.
Trisvetova E, Patorskaya O. Likely features of female coronary artery disease. EJ Cardiol Pract. 2014;12.
Leifheit-Limson EC, D’Onofrio G, Daneshvar M, Geda M, Bueno H, Spertus JA, et al. Sex Differences in Cardiac Risk Factors, Perceived Risk, and Health Care Provider Discussion of Risk and Risk Modification Among Young Patients With Acute Myocardial Infarction: The VIRGO Study. J Am Coll Cardiol. 2015 Nov 3;66(18):1949-57.
Otaki Y, Gransar H, Berman DS, Cheng VY, Dey D, Lin FY, et al. Impact of Family History of Coronary Artery Disease in Young Individuals (from the CONFIRM Registry). Am J Cardiol. 2013 Apr 15;111(8):1081-6.
Egred M, Viswanathan G, Davis GK. Myocardial infarction in young adults. Postgrad Med J. 2005 Dec 1;81(962):741-5.
Junghans C, Sekhri N, Zaman MJ, Hemingway H, Feder GS, Timmis A. Atypical chest pain in diabetic patients with suspected stable angina: impact on diagnosis and coronary outcomes. Eur Heart J - Qual Care Clin Outcomes. 2015 Jul 1;1(1):37–43.
Esteban MR, Montero SM, Sánchez JJA, Hernández HP, Pérez JJG, Afonso JH, et al. Acute Coronary Syndrome in the Young: Clinical Characteristics, Risk Factors and Prognosis. Open Cardiovasc Med J. 2014 Jul 25;8:61-7.
Iyengar SS, Gupta R, Ravi S, Thangam S, Alexander T, Manjunath CN, et al. Premature coronary artery disease in India: coronary artery disease in the young (CADY) registry. Indian Heart J. 2017 Mar 1;69(2):211–6.
Neki NS, Singh J, Bhoj, Sharma R. Clinical profile of acute myocardial infarction in young patients. Int J Curr Res Med Sci. 2017 Jul 30;3(7):1-7.
Bhardwaj R, Kandoria A, Sharma R. Myocardial infarction in young adults-risk factors and pattern of coronary artery involvement. Niger Med J Niger Med Assoc. 2014;55(1):44-7.
Abid AR, Mallick NH, Shahbaz A, Tarin SAM. In-hospital outcome of acute myocardial infarction (st segment elevation type) in diabetics and non-diabetics. J Coll Physicians Surg-Pak JCPSP. 2005 Sep;15(9):524-7.
Kim EH, Kim YH. Left Ventricular Function in Children and Adolescents With Type 1 Diabetes Mellitus. Korean Circ J. 2010 Mar;40(3):125-30.
Afridi M, Iqbal MH, Nawab Z, Ullah HE, Kakakhel SK. Influence of type 2 diabetes mellitus on the killip class in acute myocardial infarction patients visiting hayatabad medical complex, peshawar, khyber pakhtunkhwa. J Med Students. 2016 Sep 22;2(1).
Zimmerman FH, Cameron A, Fisher LD, Grace N. Myocardial infarction in young adults: Angiographic characterization, risk factors and prognosis (coronary artery surgery study registry). J Am Coll Cardiol. 1995 Sep 1;26(3):654-61.
Narayanaswamy AG, Kumar PV, Shahid M, Porchelvan S, Meenakshi K, Srinivasan V, et al. Coronary Angiographic Profile of Patients with Acute Coronary Syndrome <45 Years of Age in Rural Population of Tamil Nadu. Inter J Sci Study. 2018;6(1):4.
Galderisi M, Esposito R, Trimarco B. Cardiac Involvement in Diabetes: The Dark Side of the Moon. J Am Coll Cardiol. 2017 Sep 25;70(14):1717-9.
Kip KE, Faxon DP, Detre KM, Yeh W, Kelsey SF, Currier JW. Coronary angioplasty in diabetic patients: the national heart, lung, and blood institute percutaneous transluminal coronary angioplasty registry. Circulation. 1996 Oct 15;94(8):1818-25.
Chu Z, Yang Z, Dong Z, Zhu Z, Peng L, Shao H, et al. Characteristics of coronary artery disease in symptomatic type 2 diabetic patients: evaluation with CT angiography. Cardiovasc Diabetol. 2010 Nov 10;9(1):74.
Cho YR, Ann SH, Won KB, Park GM, Kim YG, Yang DH, et al. Association between insulin resistance, hyperglycemia, and coronary artery disease according to the presence of diabetes. Sci Rep. 2019 Sep 2;9(1):1-7.