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Acute coronary syndromes in young women.

INTRODUCTION
Acute coronary syndromes (ACS) in young women are relatively unusual. This subgroup of patients presents a premature risk of death and disability, with significant social repercussions.


OBJECTIVE/METHODOLOGY
This retrospective study was undertaken to define risk factors, symptoms and signs at presentation, electrocardiographic and angiographic characteristics, treatment and complications, in pre-menopausal women younger than fifty years old, admitted to the Coronary Care Unit between 1991 and 2002.


RESULTS
We evaluated 33 patients (mean age 43.0 years). The most frequent risk factors were hypertension (48.5%) and smoking (45.5%). Typical chest pain (78.7%) and tachycardia (34.1%) were the most prevalent symptom and sign respectively. A history of previous angina was present in 18% of the patients. The most common presenting electrocardiographic finding was ST segment elevation (45.5%). Critical coronary lesions were present in 78.7%, mainly in the left anterior descending (LAD) (54.5%). Single-vessel disease was more frequent than multi-vessel disease (57.6% vs. 18.2%). Coronary arteries were angiographically normal in 9.1%. Left ventricular dysfunction assessed by echocardiography was present in 63.6%. Recurrent angina was the most common complication (24.2%). No fatal cases were recorded. Acute reperfusion therapy was indicated in fifteen patients: direct angioplasty in six, thrombolysis in six and none in three. Elective revascularization was performed in seventeen patients (angioplasty in ten and coronary artery bypass graft in seven). Secondary prevention included platelet antiaggregants in 100%, beta-blockers in 81.5%, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in 42.2%, and statins in 42.2%. Diagnosis at discharge was Q-wave myocardial infarction (anterior--36.3% and inferior--15.2%), non-Q wave myocardial infarction (27.2%), and unstable angina (21.2%).


CONCLUSIONS
This study shows that atherosclerosis was the principal etiopathogenic factor in young women with ACS. Hypertension and smoking were the commonest risk factors. Critical LAD stenosis, Q-wave myocardial infarction (mostly anterior) and left ventricular dysfunction were common.