Journal of Clinical and Diagnostic Research. 2020 May, Vol-14(5): OC16-OC19 16 16 DOI: 10.7860/JCDR/2020/43858.13705 Original Article Internal Medicine Section A Comparative Study of Clinical and Angiographic Profile of Acute Coronary Syndrome in Young Diabetics and Non-diabetics INTRODUCTION CAD is a major cause of death all over the world. Traditionally, CAD was considered as the disease of old age group [1]. The incidence of CAD in the young people is increasing rapidly which is secondary to risk factors like stress, sedentary life style, altered food habits, which in turn predispose to the development of risk factors like DM, Metabolic syndrome, obesity which in turn propagate to CAD [2]. Other unidentified novel risk factors like lipoprotein (a), prothrombotic factors also contribute to CAD in the young [3]. The clinical presentations and the management strategies are different in younger cardiac patients as compared to their older counterpart [4]. The reasons for the differences in the clinical presentations of CAD in the younger age group are because of their varying pathophysiology and nature of coronary involvement and hence the management strategies also differ [5]. More aggressive interventions are required in many of them for improving the morbidity and mortality [1]. At present, the arbitrary age of 45 years and below is taken as cut-off age to say young in most of the studies [6]. Among the modifiable and non-modifiable risk factors, DM stands first in the list of the modifiable risk factors for CAD [7]. In young patients the incidence of CAD is higher in people with DM of relatively new onset. The spectrum of CAD includes chronic stable angina, unstable angina, Non-ST-Elevation Myocardial Infarction (NSTEMI) and STEMI. The clinical presentations vary depending on the spectrum [8]. According to most of the Western and Indian literature. typical anginal pain and dyspnea before admission is less common in the younger age group with CAD than in the older age group [9]. This is one of the reason why many of these patients reach hospital very late and hence there is an increase in morbidity and mortality. Therefore, a high index of suspicion and a low threshold for further evaluation is required in these young patients when they present with atypical symptoms, especially when they have risk factors like DM, smoking, etc. SVD and Left Anterior Descending (LAD) artery involvement is more common in younger individuals [10]. Very less data is available to compare the clinical and angiographic profile of young diabetic CAD with young non-diabetic which plays a crucial role in management. The present study was done in a tertiary care center which is best suited to study these young cardiac patients and to find the differences between young diabetic and non-diabetic CAD. This might help in formulating a management strategy and help in preventing CAD in the community [11]. MATERIALS AND METHODS It was a tertiary care hospital based comparative study, which was conducted in the Department of General Medicine and Cardiology in a tertiary care hospital in Pondicherry, India. Patients who presented with symptoms suggestive of ACS were selected as study subjects between the time period of January 2018 to June 2019. The study was approved (PG DISSERTATION/12/2017/116) by Institutional Ethical Committee. The prevalence of CAD was taken as 0.15 [1]. Sample size was calculated based on the formula for comparative and calculated a total sample size of 80. Each group required minimum of 35 patients. Inclusion criteria: Age below 45 years; Subjects presenting with ACS- Unstable angina; STEMI or NSTEMI; Those who underwent coronary angiogram with above criteria; Diabetics or with other risk factors for atherosclerosis (hypertension, dyslipidaemia, smoking and other prothrombotic state). B LAKSHMI NARAYANAN 1 , MOHAMED HANIFAH 2 , B AMIRTHA GANESH 3 Keywords: Coronary imaging, Glycaemic control, Ischemic heart disease, Nonelderly, Prognosis ABSTRACT Introduction: The clinical presentations and angiographic findings of Coronary Artery Disease (CAD) vary from diabetic and non-diabetic patients and also vary with the age of patients. CAD in patients below the age of 45 is a special subset. Clinical presentations of CAD in young patients with various risk factors differ, which may play an important role in management strategies. Aim: To compare the clinical and angiographic profile in patients presenting as Acute Coronary Syndrome (ACS) with Diabetes Mellitus (DM) and without DM below the age of 45 years. Materials and Methods: It was a comparative observational study done between the time period of January 2018 to June 2019. in patients presenting with symptoms suggestive of ACS. Patients below 45 years of age were subdivided into two major groups, Group A (ACS with DM) and Group B (ACS without DM) and analysed for the clinical and angiographic pattern. The data was analysed using SPSS software. Significance was assessed with Chi-square test. Results: Eighty ACS patients were analysed. Mean age was found to be 41.2±4.01 years, with a mean Glycated Haemoglobin (HbA1c) value of 8.65±3.3%. Clinical profile and pattern of involvement of coronary arteries, as assessed by coronary angiography were found to be different in younger CAD patients; ST-Elevation Myocardial Infarction (STEMI) was the most common type of ACS. Single Vessel Disease (SVD) was the most common angiographic finding and Echocardiography (ECHO) showed normal Left Ventricular (LV) function. Atypical chest pain and multiple vessel disease were common in diabetics with higher HbA1c (p=0.001). Conclusion: Younger and non-diabetic ACS patients get lesser burden of disease as compared with diabetics and elderly people. This finding might help in prognostication of disease.