Acute coronary syndromes in young women.
Level 4 - case-series / case-control
Retrospective case series without a control group
What was done
Retrospective single-center case series evaluating risk factors, clinical presentation, electrocardiographic and angiographic features, acute management, and in-hospital complications among 33 pre-menopausal women under 50 years of age admitted to a Coronary Care Unit with acute coronary syndromes between 1991 and 2002.
What was found
The mean age was 43.0 years. The most frequent risk factors were hypertension (48.5%) and smoking (45.5%). Typical chest pain was present in 78.7% and tachycardia in 34.1%; 18% had a history of angina. Presenting ST-segment elevation occurred in 45.5%. Angiography showed critical coronary lesions in 78.7% (left anterior descending artery in 54.5%), single-vessel disease in 57.6%, multi-vessel disease in 18.2%, and normal coronary arteries in 9.1%. Left ventricular dysfunction was detected in 63.6%. Recurrent angina occurred in 24.2%, and in-hospital mortality was 0%. Reperfusion was indicated in 15 patients (direct angioplasty in 6, thrombolysis in 6, none in 3). Elective revascularization included angioplasty in 10 and bypass surgery in 7. Discharge diagnoses were Q-wave MI in 51.5% (anterior 36.3%, inferior 15.2%), non-Q wave MI in 27.2%, and unstable angina in 21.2%. Secondary prevention at discharge included antiplatelets (100%), beta-blockers (81.5%), ACE inhibitors or ARBs (42.2%), and statins (42.2%).
Why it matters
The findings demonstrate that traditional atherosclerotic disease, primarily associated with smoking and hypertension, accounts for the majority of acute coronary syndromes in pre-menopausal women.
Limits
The study is limited by a very small sample size (n=33), a single-center retrospective design spanning 11 years over which management standards evolved, and the absence of a control group (such as older women or age-matched men). Long-term post-discharge outcomes and non-atherosclerotic mechanisms were not evaluated.
Cited by
- supports Cigarette smoking eliminates most of the cardiovascular disease protection naturally observed in premenopausal women.