Acute Coronary Syndrome patterns in the Young: risk factor profile and in-hospital outcome in a tertiary referral hospital in Kenya

Abstract

Introduction Acute coronary syndrome (ACS) accounts for coronary artery disease–related morbidity and mortality. There has been growing concern about the rising incidence of ACS among young adults globally both in developed and developing countries, including Sub Saharan Africa. This groups phenotypic characteristics; risk factors and clinical outcomes are not well described. Contextual and regional studies are necessary to understand the magnitude of ACS among young Individuals and help highlight challenges and opportunities for improved ACS outcomes in the region. The study aimed to describe the characteristics of young individuals hospitalized with ACS and report on in-hospital outcomes. Methodology This single-center retrospective study was conducted at the Aga Khan University Hospital, Nairobi. Medical records of young individuals hospitalized with ACS from 30th June 2020 to 1st May 2023 were reviewed. We defined young as 50 years or below. Categorical variables were reported as frequencies and proportions, and compared with chi- squared or Fisher’s exact tests. Continuous variables were reported as means or medians and compared with t-tests or Mann-Whitney U tests. Results Among 506 Patients hospitalized with ACS, (n= 138,27.2%) were aged 50 years and below. The study population was male (n=107, 79.9%) and African(n=82,61.2%) Predominant with a median age of 46.5 years (IQR 41.0- 50.0). Hypertension (n=101,75.4%) was noted in most study participants. More than half of the cohort were smokers (n=69,51.5%) having a family history of premature ASCVD(n=70,52.2%) and were on lipid-lowering therapy(n=68,50.7%) prior to presentation. ST-segment–elevation myocardial infarction (STEMI) was the most common clinical manifestation of ACS (n=77, 57.5%). Of the significant coronary artery disease (n=75,56.0%), majority of the individuals had single vessel disease (n=60, 80%) with a predilection of Left Anterior deciding artery(n=47,62.6%). The Main cause of ACS was atherosclerosis (n=41,54.6%). The mean left ventricular ejection fraction was 46.0 (± 12.4). The In-hospital mortality was (n= 2, 1.5%) Conclusion This study highlights that young patients contribute to a relatively large proportion of patients presenting with ACS at our center. The most common presentation was STEMI. Findings of this study highlight the importance of awareness campaigns and developing systems of care that enable early detection and reperfusion. Traditional cardiovascular risk factors were prevalent and thus targets of intervention.