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The lecture presents the content suboptimal implementation of prevention strategies and uncontrolled cardiovascular risk factors; atherosclerosis begins with the origin of life; statistics corresponding to patients admitted with acute coronary syndrome, institute of Cardiology, Havana Cuba...
Acute coronary syndrome in young Cuban adults under 45 years old Cardiology and cardiac surgery Institute Havana Cuba Dr Piter Martínez Benítez Specialist in Cardiology Professor and researcher Cardiology and cardiac surgery Institute Havana Cuba Interventional Cardiologist Vietnam-Cuba Dong Hoi Friendship Hospital hinhanhykhoa.com ❖ CVDs, diabetes, cancer, obesity and respiratory diseases, account for about 60% of the 56.5 million deaths each year, and almost half of the global burden of disease Coronary heart disease will be the one of main causes ❖ Although there has been substantial improvement in atherosclerotic cardiovascular disease outcomes in recent decades, it remains the leading cause of morbidity and mortality globally Much of this attributable to suboptimal implementation of prevention strategies and uncontrolled cardiovascular risk factors When does the atherosclerosis start? When the sperm penetrates the egg and we are a single fertilized cell, the genes and epigenetics of the mother, father and family are present and their atherogenic risk factors are contained in them Atherosclerosis begins with the origin of life What are risk factors of atherosclerosis in the 21st century? Tobacco (smoke) Carbon monoxide Fast Food Excessive alcohol Sedentary lifestyle TV Controls Chips Excess Sugar and Salt Occupational stress Family competition Job competition Wage dissatisfaction Family charge Conflicting neighbors Sick family How many of those risk factors could be present in the VI Egyptian Dynasty 2670-2140 B.C.? ❖ Yater 1948 is recognized as a common coronary heart disease in young people ❖ CHD in young adults are not as well characterized as CHD in older because it occurs less frequently ❖ This disease can have devastating consequences for young patients and their families ❖ The differences in etiologies and risk profiles of younger and older patients result in differences in disease progression, prognosis, and treatment ❖ Limited data suggest that prognosis may be better in the young population Statistics corresponding to patients admitted with acute coronary syndrome Institute of Cardiology Havana Cuba 80 70 69 60 50 STE-MI 40 30 30 20 18 10 24 17 2006-2008 2009-2012 2013-2014 NSTE-ACS Hypothesis What are the clinical, electrocardiographic and anatomofunctional characteristics of young adult with ACS? What are the most common reperfusion strategies and complications in these patients? Objectives • To determine the clinical, electrocardiographic and anatomic-functional characteristics of young adults with ACS • To identify the most common reperfusion strategies and complications in these patients Methods An observational cross sectional study 99 patients were selected (a sample) that accomplished inclusion criteria from the 947 patients with a confirmed diagnosis of acute coronary syndrome who entered the institute between January 2013 and December 2014 hinhanhykhoa.com Results Figure Types of presentation of acute coronary syndrome per gender and age N Age 41,9% 80 60 40 20 69 N Men 82.8% 30 STE-MI NSTE-ACS Results Figure Risk factors in patients with acute coronary syndrome % Cancer 21,2 Obesity 41,4 Personal History % 48,4 High bood Cholesterol 58,6 Hypertension 76,8 Tobacco use 20 40 hinhanhykhoa.com 60 80 Results Table Types of presentation of acute coronary syndrome according to number of vessels affected Presentation Number of arteries STE-MI Total NSTE-ACS 6,1 16 16,2 22 22,2 13 13,1 18 18,2 31 31,3 7,1 13 13,1 20 20,2 4,0 22 22,2 26 26,3 Results Table Types of presentation of acute coronary syndrome according to the guildy artery of the event Presentation Culpit Artery STE-MI Total NSTE-ACS LM 0 1 1 LAD 10 10,1 30 30,3 40 40,4 CX 1 4,0 5,1 RD 13 13,1 18 18,2 31 31,3 NO 6,1 16 16,2 22 22,2 hinhanhykhoa.com Results Table Left ventricle ejection fraction in patients with acute coronary syndrome according to the number of vessels affected Number of arteries IF Normal Total Decreased 18 18,2 4,0 22 22.2 22 22,2 9,1 31 31,3 12 12,1 8,1 20 20,2 15 15,2 11 11,2 26 26,3 Results Reperfusion treatment in acute coronary syndrome with ST segment elevation % 16,6 23,3 Thrombolysis (5) Primary PCI (9) Rescue PCI (8) 3,3 30,0 Surgery (1) no (7) 26,6 hinhanhykhoa.com Results Reperfusion treatment in the acute coronary syndrome without elevation of the ST segment % 21,7 Early PCI (15) 36,2 Late PCI (19) CABGS (10) 27,5 14,5 No (25) Conclusions • The gender distribution in young adults with ACS is similar to in older patients • Most patients with ACS had cardiovascular risk factors • The small extent of coronary artery disease justified: the preservation of ventricular function, after ischemic event and thus the low percentage of complications • The PCI was the most widely used reperfusion strategy in STE-MI, although there was under-utilization of this technique in NSTE-ACS hinhanhykhoa.com Recommendations • To implement early-life promotion and prevention activities, base on cardiovascular risk factors in order to prevent the consequences and economic costs of CHD • Screening CHD in young population may help to improve prognosis by detecting subclinical disease • Additional researches must also focus on treatment concerns that are specific to young patients Thank you for your kind attention hinhanhykhoa.com .. .Acute coronary syndrome in young Cuban adults under 45 years old Cardiology and cardiac surgery Institute Havana Cuba Dr Piter Martínez Benítez Specialist in Cardiology Professor and researcher... researcher Cardiology and cardiac surgery Institute Havana Cuba Interventional Cardiologist Vietnam -Cuba Dong Hoi Friendship Hospital hinhanhykhoa.com ❖ CVDs, diabetes, cancer, obesity and respiratory... the young population Statistics corresponding to patients admitted with acute coronary syndrome Institute of Cardiology Havana Cuba 80 70 69 60 50 STE-MI 40 30 30 20 18 10 24 17 200 6-2 008 200 9-2 012