Abstract 13658: Acute Coronary Syndrome Presentation Among Young Patients in New Delhi and Boston

Abstract

Background: India’s coronary heart disease prevalence is up to 13%, compared with 6% in the US. Prior studies suggest that patients with acute coronary syndrome (ACS) in India are younger and more likely to have STEMI than US patients. To investigate these differences further, we studied young ACS patients presenting to 2 large academic medical centers in India and the US.

Methods: We prospectively enrolled all ACS admissions to Medanta Hospital (Delhi, India) in June and July, 2011. In addition, we retrospectively studied all ACS patients ≤45 years admitted to Massachusetts General Hospital (Boston, USA) in 2011.

Results: In Delhi, 121 patients presented with a first ACS event, 23 (19%) of whom were age ≤45 years. In Boston, 35 patients presented with ACS at age ≤45 years (6% of all ACS admits in 2011). In Delhi, young patients had a higher STEMI rate than middle aged (46-70 years) or older patients (>70 years; 74% vs 53% vs 44%, p=0.04). Young Delhi patients also had a higher STEMI rate than young Boston patients (74% vs 54%, p=0.01), and lower LVEF (42% ± 2 vs 54% ± 2, p=0.0002). The culprit coronary vessel did not differ by age group or country. With regard to cardiovascular risk profile, young Delhi patients had higher LDL and lower HDL levels than older Delhi patients (Fig 1), or young Boston patients (Table 1). Young Delhi patients had lower BMI than young Boston patients (Table 1). The smoking rate was higher in young Delhi patients than in older Delhi patients (56.5% vs 30.9% vs 20.8%, p=0.03), while diabetes or pre-diabetes was less common (35% vs 76% vs 84%, p=0.0002). However, smoking and diabetes rates were similar between young patients in Delhi and Boston.

Conclusions: Three-quarters of ACS patients ≤45 years old in Delhi present with STEMI, a rate substantially higher than in either young ACS patients in Boston or older ACS patients in Delhi. The principal characteristic distinguishing young ACS patients in Delhi is their worse lipid profile, which is not explained by differences in BMI.