Document Type : Original Article(s)


1 Assistant Professor, Department of Cardiology, Laxmipat Singhania (LPS) Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, India

2 Professor, Department of Cardiology, Laxmipat Singhania (LPS) Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, India

3 Senior Researcher, Department of Cardiology, Laxmipat Singhania (LPS) Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, India

4 Department of Cardiology, Laxmipat Singhania (LPS) Institute of Cardiology, Ganesh Shankar Vidyarthi Memorial (GSVM) Medical College, Kanpur, India


BACKGROUND: India is currently in the fourth stage of epidemiological transitions where cardiovascular disease is the leading cause of mortality and morbidity. Purpose of the present study was to assess the risk factors, clinical presentation, angiographic profile including severity, and in-hospital outcome of very young adults (aged ≤ 30 years) with first acute myocardial infarction (AMI). METHODS: Total of 1,116 consecutive patients with ST-segment elevation acute myocardial infarction (STEMI) were studied between March 2013 and February 2015 at LPS Institute of Cardiology, Kanpur, Uttar Pradesh, India. RESULTS: Mean age of the patients was 26.3 years. Risk factors were smoking (78.5%), family history of premature coronary artery disease (CAD) (46.8%), obesity (39.1%), physical inactivity (38.7%) and stressful life events (29.6%). The most common symptom and presentation was chest pain and anterior wall MI (AWMI) in 94.8% and 58.8%, respectively. About 80.6% of patients had obstructive CAD with single vessel disease (57.6%), double-vessel disease (12.9%) and left main involvement (3.2%). Left anterior descending (LAD) was commonest culprit artery (58.1%) followed by right coronary artery in 28.2%. In-hospital mortality was 2.8%. Percutaneous coronary intervention was performed in 71.6% of patients. Median number and length of stent were 1.18 and 28 ± 16 mm, respectively. CONCLUSION: AMI in very young adult occurred most commonly in male. Smoking was the most common risk factor. AWMI owing to LAD artery involvement was the most common presentation. Mean time of presentation after symptom onset was 16.9 hours. In contrast to western population, it is characterised by earlier onset, delayed presentation, more severity, diffuse disease, and more morbidity but with favourable in-hospital mortality 


  1. American Heart Association. American Stroke Association statistical data on highlights of acute coronary syndrome. Washington, DC: American Heart Association; 2005.
  2. Murray CJ, Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997; 349(9061): 1269-76.
  3. Mohan V, Deepa R, Rani SS, Premalatha G. Prevalence of coronary artery disease and its relationship to lipids in a selected population in South India: The Chennai Urban Population Study (CUPS No. 5). J Am Coll Cardiol 2001; 38(3): 682-7.
  4. Gupta AK, Bharadwaj A, Ashotra S, Gupta BP. Feasibility and training of multipurpose workers in detection, prevention and control of coronary artery disease in apple-belt of Shimla hills. South Asian J Prev Cardiol 2002; 6: 17-22.
  5. Cassar A, Holmes DR Jr, Rihal CS, Gersh BJ. Chronic coronary artery disease: Diagnosis and management. Mayo Clin Proc 2009; 84(12): 1130-46.
  6. Jalowiec DA, Hill JA. Myocardial infarction in the young and in women. Cardiovasc Clin 1989; 20(1): 197-206.
  7. Egred M, Viswanathan G, Davis GK. Myocardial infarction in young adults. Postgrad Med J 2005; 81(962): 741-5.
  8. Fournier JA, Cabezon S, Cayuela A, Ballesteros SM, Cortacero JA, Diaz De La Llera LS. Long-term prognosis of patients having acute myocardial infarction when
  9. Chadha SL, Radhakrishnan S, Ramachandran K, Kaul U, Gopinath N. Epidemiological study of coronary heart disease in urban population of Delhi. Indian J Med Res 1990; 92: 424-30.
  10. Enas EA, Yusuf S, Mehta JL. Prevalence of coronary artery disease in Asian Indians. Am J Cardiol 1992; 70(9): 945-9.
  11. Jneid H, Fonarow GC, Cannon CP, Hernandez AF, Palacios IF, Maree AO, et al. Sex differences in medical care and early death after acute myocardial infarction. Circulation 2008; 118(25): 2803-10.
  12. Kanitz MG, Giovannucci SJ, Jones JS, Mott M. Myocardial infarction in young adults: Risk factors and clinical features. J Emerg Med 1996; 14(2): 139-45.
  13. Bangalore S, Fonarow GC, Peterson ED, Hellkamp AS, Hernandez AF, Laskey W, et al. Age and gender differences in quality of care and outcomes for patients with ST-segment elevation myocardial infarction. Am J Med 2012; 125(10): 1000-9.
  14. Enas EA, Yusuf S, Mehta J. Meeting of the international working group on coronary artery disease in South Asians. 24 March 1996, Orlando, Florida, USA. Indian Heart J 1996; 48(6): 727-32.
  15. Wenger NK, Speroff L, Panhard B. Cardiology heart disease morbidity and mortality in the sexes; a 26 year follow-up of the Framingham population. Am Heart J 1989; 113: 383-90.
  16. Hochman JS, Tamis JE, Thompson TD, Weaver WD, White HD, Van de Werf F, et al. Sex, clinical presentation, and outcome in patients with acute coronary syndromes. Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb Investigators. N Engl J Med 1999; 341(4): 226-32.
  17. Yusuf S, Hawken S, Ounpuu S, Dans T, Avezum A, Lanas F, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): Case-control study. Lancet 2004; 364(9438): 937-52.
  18. Glover MU, Kuber MT, Warren SE, Vieweg WV. Myocardial infarction before age 36: Risk factor and arteriographic analysis. Am J Cardiol 1982; 49(7): 1600-3.
  19. Tewari S, Kumar S, Kapoor A, Singh U, Agarwal A, Bharti BB, et al. Premature coronary artery disease in North India: an angiography study of 1971 patients. Indian Heart J 2005; 57(4): 311-8.
  20. Wolfe MW, Vacek JL. Myocardial infarction in the young. Angiographic features and risk factor analysis of patients with myocardial infarction at or before the age of 35 years. Chest 1988; 94(5): 926-30.
  21. Weinberger I, Rotenberg Z, Fuchs J, Sagy A, Friedmann J, Agmon J. Myocardial infarction in young adults under 30 years: Risk factors and clinical course. Clin Cardiol 1987; 10(1): 9-15.
  22. Lakka HM, Lakka TA, Tuomilehto J, Salonen JT. Abdominal obesity is associated with increased risk of acute coronary events in men. Eur Heart J 2002; 23(9): 706-13.
  23. Masoomi M, Bahrampour A, Mireskandri M, Nematolahi A. Plasma homocysteine concentrations in young patients with acute myocardial infarction. ARYA Atheroscler 2007; 2(4): 193-6.
  24. Wang J, Dudman NP, Wilcken DE. Effects of homocysteine and related compounds on prostacyclin production by cultured human vascular endothelial cells. Thromb Haemost 1993; 70(6): 1047-52.
  25. Hughes LO, Wojciechowski AP, Raftery EB. Relationship between plasma cholesterol and coronary artery disease in Asians. Atherosclerosis 1990; 83(1): 15-20.
  26. Hosseini SK, Soleimani A, Salarifar M, Pourhoseini H, Nematipoor E, Abbasi SH, et al. Demographics and angiographic findings in patients under 35 years of age with acute st elevation myocardial infarction. J Tehran Heart
  27. Cent 2011; 6(2): 62-7.
  28. Thomas CS, Cherian G, Abraham MT, Hayat NJ, Lulu AR, Bisharatullah MS, et al. Clinical and angiographic features in patients under 35 years with a first Q wave acute myocardial infarction. Int J Cardiol 1999; 69(3): 263-70.
  29. Moret P, Gutzwiller F, Junod B. Coronary artery disease in young adults under 35 years old: Risk factors (Swiss Survey). In: Roskamm H, Editor. Myocardial infarction at young age. Berlin, Germany: Springer; 1981. p. 17-22.
  30. Mohammad AM, Sabri KS, Jasim MT. Relation of cardiovascular risk factors with coronary angiographic findings in Iraqi patients with ischemic heart disease. American Journal of Cardiovascular Disease Research 2013; 1(1): 25-9.
  31. Kumar N, Sharma S, Mohan B, Beri A, Aslam N, Sood N, et al. Clinical and angiographic profile of patients presenting with first acute myocardial infarction in a tertiary care center in northern India. Indian Heart J 2008; 60(3): 210-4.
  32. Ghadimi H, Bishehsari F, Allameh F, Bozorgi AH, Sodagari N, Karami N, et al. Clinical characteristics, hospital morbidity and mortality, and up to 1-year follow-up events of acute myocardial infarction patients: The first report from Iran. Coron Artery Dis 2006; 17(7): 585-91.