Acute coronary syndrome (ACS) includes several clinical conditions such as ST-elevation myocardial infarction (STEMI), non-ST-elevation myocardial infarction (NSTEMI), or unstable angina, which are characterized by an abrupt decrease in the blood supply to the heart. The prevalence of ACS, a major cause of cardiovascular morbidity and mortality in the world is huge, posing an important public health predicament [1]. The clinical manifestation and prognosis in ACS can differ significantly from each other, for example, the age of patients, gender, comorbidity. Age is a significant factor affecting ACS prognosis and patients between different age groups present distinct clinical features, disease development as well as therapeutic effects [2]. Age is the most widely recognized risk factor for CAD, and is especially important in the setting of ACS. Although young patients (≤ 45 years of age) have fewer comorbidities, including diabetes and hypertension, their symptoms are more severe than the old patients, with a longer time taken for diagnosis [3]. In contrast, older patients (>45 years) are likely to have a combination of several predisposing risk factors (dyslipidemia, hypertension and diabetes mellitus) which contributes to an atypical presentation of ACS [4]. These disparities in clinical presentation and comorbidity profiles indicate that the treatment of ACS in younger versus older patients may necessitate unique treatment strategies. It is well known that age determines the clinical outcome of the acute coronary syndrome (ACS); however, comparatives study to compare two groups in a same time as their presentations, risk profiles, biochemically markers and angiographical features at admission have not been investigated. This lack of knowledge also acts as the barrier in development of age-specific managements and early interventions that could ameliorate the prognosis of ACS patients [5] [6] [7].

This prospective study was conducted in a tertiary cardiac care center from January to December 2024 to evaluate the demographic, clinical, biochemical, angiographic profile and short-term outcomes of 800 patients with Acute Coronary Syndrome (ACS) and compared between young (45 yrs.) population. Patients were enrolled with a non-probability consecutive sampling method and inclusion criteria for those aged ≥18 years and diagnosed as any subtype of ACS (patients who had chronic liver failure, chronic renal failure, terminal cancer or severe comorbidities were excluded). Demographic parameters, cardiovascular risk factors (smoking hypertension diabetes dyslipidemia family history of CAD), clinical symptoms at presentation (chest pain shortness of breath palpitation syncope sweating) biochemical data [total cholesterol low-density lipoprotein high-density lipid and triglyceride and very-low density lipid (VLDL)] and angiogram findings (single/multi-vessel disease) were recorded on a pre-designed proforma. In addition, treatment strategies including thrombolysis, PCI, or medical management and short-term outcomes including in-hospital mortality, cardiac arrest, heart failure and length of stay (LOS) were documented. The SPSS version 25 was used in the data analysis and student-t test and chi-square tests were applied to compare the studied variables between two groups with a significance level of p<0.05. This study was approved by the Institutional Review Board, and all participants provided informed consent. The study hoped to illuminate age-related discrepancy in ACS presentation and outcomes, however it is limited by a single center design which precludes generalization and causative inference

Approximately 28.75% of the total cohort were younger patients, aged 45 or less, and 71.25% were older patients, aged more than 45. The total cohort’s mean age was 54.2 years, and the average ages of the two groups were 39.8 years and 63.5 years, respectively. Moreover, the distribution of the sexes was also different. The younger group had more males 80% versus 60% in the remaining group. The two groups were also dissimilar with regard to risk factors. Smoking was more prevalent in the more youthful patients. In contrast, smokers represented only 30% in the older group. Other risk factors such as hypertension, diabetes mellitus, and dyslipidemia were more prevalent in older patients. However, a family history of CAD was more prevalent in the younger group, implying that younger patients have a genetic predisposition to the early manifestation of CAD. Similarly, chest pain was more frequent in both groups. Notably, 88% of the total cohort experienced chest pain. The only symptom that effected more the sexagenarian patients was short breathing. The remaining symptoms such as palpitations, syncope, and sweating were more prevalent among older patients. This suggests that older patients experience more severe forms of ACS and their symptoms are more severe. The younger patients presented with more favorable lipid panels. The younger patients had lower values of total cholesterol, 180 mg/dL versus 220 mg/dL, LDL cholesterol, 110 mg/dL versus 140 mg/dl, and triglycerides, 150 mg/dL versus 180 mg/dL. Whereas, the value of HDL cholesterol, 40 mg/dL versus 35 mg/dL was slightly higher among the younger ones. This implies that younger patients have better lipid profiles. The worst two angiographic discoveries about familial history and short breathing signs resulting from ACS found in older familial patients also supports these assumptions. Most of younger patients had a single vessel disease, 65%, while only 40% had this kind of disease with older patients. But 50% of the patients above 45 presented with a multi-vessel disease, while only 20% of young patients had it. The former two results imply that younger patients had a more robust CAD, and the other, two suggest that older patients had more advanced forms of CAD, probably due to the impact of the long-term untreated hypertension, diabetes, and dyslipidemia. The younger patients had better short-term outcomes. The mortality in younger and the older groups was 2% and 8%, respectively. The rates of both cardiac arrest and heart failure were lower with younger patients, 1% versus 5% and 1% versus 4%. The average hospital stay was also longer with older patients, 4.5 days versus 6.2 days.

1. Demographic and Risk Factor Distribution

2. Clinical Presentation of ACS

3. Biochemical and Lipid Profile Results

4. Angiographic Findings

5. Short-Term Outcomes of ACS

The clinical presentation, risk descriptors, angiographic features, biochemical markers and short-term outcomes between younger (≤45 years) and older (>45 years) patients with ACS were compared in this study. The younger group (mean age: 39.8 ± 5.2 years) was also more male predominant (80%) than the older group (70%), which has been a uniform finding among previous series of ACS studies [8]. Smoking was the dominant risk factor in the younger age group (60%), consistent with evidence that lifestyle factors, including smoking, play a major role on developing ACS in patients aged 45 years). The results emphasize that younger patients, in general, have less comorbidity such as hypertension, diabetes and dyslipidemia than their elders as well as better lipid profile. They also have less severe CAD with a greater number of cases of single-vessel disease. On the other hand, older patients display a more advanced cardiovascular disease and higher prevalence of hypertension, diabetes, hyperlipidemia and extensive CAD including multi-vessel diseases. Younger patients have better short-term clinical outcomes including lower in-hospital mortality and fewer complications such as cardiac arrest, heart failure. Older patients do worse, with greater mortality rates, more complications and lengthier hospital admissions. Implications These results highlight the need for focused prevention and treatment efforts, specifically targeting risk factors such as dyslipidemia, hypertension, and diabetes in older ACS patients to enhance quality of care 33,

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