Sudan Journal of Medical Sciences
ISSN: 1858-5051
High-impact research on the latest developments in medicine and healthcare across MENA and Africa
Clinical Features, Risk Factors, and Outcomes of Acute Coronary Syndrome in Young Sudanese Patients: A Retrospective Single-Tertiary Care Center Study
Published date: Jun 30 2025
Journal Title: Sudan Journal of Medical Sciences
Issue title: Sudan JMS: Volume 20 (2025), Issue No. 2
Pages: 160 - 170
Authors:
Abstract:
Background: Coronary artery disease (CAD) is a leading cause of death worldwide, even in young patients. This study aimed to characterize the clinical features, risk factors, and prognosis of acute coronary syndrome (ACS) in young Sudanese patients.
Methods: A total of 100 Sudanese patients aged up to 45 years with ACS were enrolled in a retrospective cross-sectional study at the Sudan Heart Center from 2022 to 2023. Their clinical data, including the findings, management, and outcome of their electrocardiogram (ECG), echocardiography, and coronary angiography within one month, were recorded and analyzed using the SPSS program version 25.
Results: Of the 100 patients, 74% were male and 26% were female, and the median age was 39. Risk factors included hypertension (33%), diabetes mellitus (30%), obesity (26%), and smoking (25%). ST-elevation myocardial infarction (STEMI) occurred in 73% of cases, mild ejection fractions occurred in 45 patients, and mitral regurgitation and left ventricular thrombosis each occurred in six patients. Most patients (73%) had occlusive CAD, primarily in the left anterior descending (LAD) artery (74%). Of the patients, 34% received thrombolysis, 26% had percutaneous coronary intervention (PCI), and 16% had coronary artery bypass grafting (CABG). Adverse events were significantly higher with a P-value of 0.000 in patients with diabetes, hypertension, a smoking habit, hyperlipidemia, obesity, occlusive CAD, and multivessel involvement (P = 0.001).
Conclusion: Classical risk factors, especially hypertension, continue to significantly contribute to CAD and ACS in young adults in Sudan. It is imperative to prioritize interventions to prevent or mitigate these risk factors, including implementing strategies for blood pressure regulation, blood glucose monitoring, smoking cessation, and lipid management in young adults.
References:
[1] Mohammad, A. M., Rashad, H. H., Habeeb, Q. S., Rashad, B. H., & Saeed, S. Y. (2021). Demographic, clinical and angiographic profile of coronary artery disease in Kurdistan region of Iraq. American Journal of Cardiovascular Disease, 11(1), 39–45. PMID:33815918
[2] Yagel, O., Shadafny, N., Eliaz, R., Dagan, G., Leibowitz, D., Tahiroglu, I., Planer, D., Amir, O., Elbaz Greener, G., & Alcalai, R. (2021). Long-term prognosis in young patients with acute coronary syndrome treated with percutaneous coronary intervention. Vascular Health and Risk Management, 17, 153–159. https://doi.org/10.2147/VHRM.S298436 PMID:33907409
[3] de Andrade, P. B., Rinaldi, F. S., de Castro Bienert, I. R., Barbosa, R. A., Bergonso, M. H., de Matos, M. P. B., de Souza, M. F. M, Nogueira E. F., Kreimer, S., Esteves, V. C., Tebet, M. A., Mattos, L. A. P., & Labrunie, A. (2015). Perfil clínico e angiográfico de pacientes jovens submetidos à intervenç ao coronária percutânea primária [Clinical and angiographic profile of young patients undergoing primary percutaneous coronary intervention]. Revista Brasileira de Cardiologia Invasiva, 23(2), 91– 95. https://doi.org/10.1016/j.rbci.2015.12.005
[4] Suri, P., Arora, A., Kinra, K., & Arora, V. (2023). Risk factors and angiographic profile in young individuals with acute STelevation myocardial infarction (STEMI). Indian Journal of Clinical Cardiology., 4(4), 242–247. https://doi.org/10.1177/26324636231199029
[5] Revaiah, P. C., Vemuri, K. S., Vijayvergiya, R., Bahl, A., Gupta, A., Bootla, D., Kasinadhuni, G., Nevali, K. P., Palanivel Rajan, M., Uppal, L., Gawalkar, A., & Rohit, M. (2021). Epidemiological and clinical profile, management and outcomes of young patients (≤40 years) with acute coronary syndrome: A single tertiary care center study. Indian Heart Journal, 73(3), 295–300. https://doi.org/10.1016/j.ihj.2021.01.015 PMID:34154745
[6] Gulati, R., Behfar, A., Narula, J., Kanwar, A., Lerman, A., Cooper, L., & Singh, M. (2020). Acute Myocardial Infarction in Young Individuals. Mayo Clinic Proceedings, 95(1), 136–156. https://doi.org/10.1016/j.mayocp.2019.05.001
[7] Murthy, N. S., Nandakumar, B. S., Pruthvish, S., George, P. S., & Mathew, A. (2010). Disability adjusted life years for cancer patients in India. Asian Pacific Journal of Cancer Prevention: APJCP, 11(3), 633–640. PMID:21039029
[8] Singh, B., Singh, A., Goyal, A., Chhabra, S., Tandon, R., Aslam, N., Mohan, B., & Wander, G. S. (2019). The prevalence, clinical spectrum and the long term outcome of ST-segment elevation myocardial infarction in young—A prospective observational study. Cardiovascular Revascularization Medicine: Including Molecular Interventions, 20(5), 387–391. https://doi.org/10.1016/j.carrev.2018.07.020 PMID:30068493
[9] Mark, D. B. (1994). An overview of risk assessment in coronary artery disease. The American Journal of Cardiology, 73(6), 19B– 25B. https://doi.org/10.1016/0002-9149(94)90261- 5PMID:8141075
[10] Raffee, L. A., Alawneh, K. Z., Ibdah, R. K., Rawashdeh, S. I., Zoghoul, S., Ewais, A. S., & Al-Mistarehi, A. H. (2020). Prevalence, clinical characteristics, and risk among patients with ischemic heart disease in the young Jordanian population. Open Access Emergency Medicine: OAEM, 12, 389–397. https://doi.org/10.2147/OAEM.S272961
[11] Srikanth, S., Mondal, A., Aggarwal, S., Alle, N. R., Odugbemi, O., Nayak, P. R., Vyas, A., & Desai, R. (2024). Key hypertension breakthroughs and emerging trends from the AHA’s scientific sessions. Current Problems in Cardiology, 49(4), 102434. https://doi.org/10.1016/j.cpcardiol.2024.102434 PMID:38309547
[12] Jariwala, P., Padmavathi, A., Patil, R., Chawla, K., & Jadhav, K. (2022). The prevalence of risk factors and pattern of obstructive coronary artery disease in young Indians (< 45 years) undergoing percutaneous coronary intervention: A genderbased multi-center study. Indian Heart Journal, 74(4), 282–288. https://doi.org/10.1016/j.ihj.2022.07. 001 PMID:35843268
[13] Yandrapalli, S., Nabors, C., Goyal, A., Aronow, W. S., & Frishman, W. H. (2019). Modifiable risk factors in young adults with first myocardial infarction. Journal of the American College of Cardiology, 73(5), 573–584. https://doi.org/10.1016/j.jacc.2018. 10.084 PMID:30732711
[14] Yunyun, W., Tong, L., Yingwu, L., Bojiang, L., Yu, W., Xiaomin, H., Xin, L., Wenjin, P., & Li, J. (2014). Analysis of risk factors of ST-segment elevation myocardial infarction in young patients. BMC Cardiovascular Disorders, 14(1), 179. https://doi. org/10.1186/1471-2261-14-179 PMID:25487289
[15] Tsai, W. C., Wu, K. Y., Lin, G. M., Chen, S. J., Lin, W. S., Yang, S. P., Cheng, S. M., & Lin, C. S. (2017). Clinical characteristics of patients less than forty years old with coronary artery disease in Taiwan: A crosssectional study. Zhonghua Minguo Xinzangxue Hui Zazhi, 33(3), 233–240. PMID:28559653
[16] Kanitz, M. G., Giovannucci, S. J., Jones, J. S., & Mott, M. (1996). Myocardial infarction in young adults: Risk factors and clinical features. The Journal of Emergency Medicine, 14(2), 139–145. https://doi.org/ 10.1016/0736-4679(95)02089-6 PMID:8740743
[17] Bhardwaj, R., Kandoria, A., & Sharma, R. (2014). Myocardial infarction in young adults—Risk factors and pattern of coronary artery involvement. Nigerian Medical Journal: Journal of the Nigeria Medical Association, 55(1), 44–47. https://doi.org/10.4103/ 0300-1652.128161 PMID:24970969
[18] Tamrakar, R., Bhatt, Y. D., Kansakar, S., Bhattarai, M., Shaha, K. B., & Tuladhar, E. (2014). Acute myocardial infarction in young adults: Study of risk factors, angiographic features and clinical outcome. Nepalese Heart Journal, 10(1), 12–16. https://doi.org/ 10.3126/njh.v10i1.9740
[19] Sinha, S. K., Krishna, V., Thakur, R., Kumar, A., Mishra, V., Jha, M. J., Singh, K., Sachan, M., Sinha, R., Asif, M., Afdaali, N., & Mohan Varma, C. (2017). Acute myocardial infarction in very young adults: A clinical presentation, risk factors, hospital outcome index, and their angiographic characteristics in North India- AMIYA Study. ARYA Atherosclerosis, 13(2), 79–87. PMID:29026414
[20] Deora, S., Kumar, T., Ramalingam, R., & Nanjappa Manjunath, C. (2016). Demographic and angiographic profile in premature cases of acute coronary syndrome: Analysis of 820 young patients from South India. Cardiovascular Diagnosis and Therapy, 6(3), 193–198. https://doi.org/10.21037/cdt.2016.03. 05 PMID:27280082
[21] Iragavarapu, T., Radhakrishna, T., Babu, K. J., & Sanghamitra, R. (2019). Acute coronary syndrome in young—A tertiary care centre experience with reference to coronary angiogram. Journal of the Practice of Cardiovascular Sciences, 5(1), 18–25. https://doi.org/10.4103/jpcs.jpcs_74_18
[22] Nordenskjöld, A. M., Baron, T., Eggers, K. M., Jernberg, T., & Lindahl, B. (2018). Predictors of adverse outcome in patients with myocardial infarction with non-obstructive coronary artery (MINOCA) disease. International Journal of Cardiology, 261, 18–23. https://doi.org/10.1016/j.ijcard.2018. 03.056 PMID:29563017
[23] Pathak, V., Ruhela, M., Chadha, N., & Jain, S. (2015). Risk factors, angiographic characterization and prognosis in young adults presented with acute coronary syndrome at a tertiary care center in North India. BMR Medical, 1, 1–5.
[24] Gao, H., Wang, Y., Shen, A., Chen, H., & Li, H. (2021). Acute myocardial infarction in young men under 50 years of age: Clinical characteristics, treatment, and long-term prognosis. International Journal of General Medicine, 14, 9321–9331. https://doi.org/10. 2147/IJGM.S334327 PMID:34898997
[25] Marceau, A., Samson, J. M., Laflamme, N., & Rinfret, S. (2013). Short and long-term mortality after STEMI versus non-STEMI: A systematic review and meta-analysis. Journal of the American College of Cardiology, 61(10), E96. https://doi.org/10.1016/ S0735-1097(13)60097-2
[26] Maroszyńska-Dmoch, E. M., & Wożakowska-Kapłon, B. (2016). Clinical and angiographic characteristics of coronary artery disease in young adults: A single centre study. [Kardiologia Polska]. Kardiologia Polska, 74(4), 314–321. https://doi.org/10.5603/KP. a2015.0178 PMID:26365941
[27] Noor, L., Adnan, Y., Dar, M. H., Umair, A., Ahmad, F., & Awan, Z. A. (2018). Characteristics of the coronary arterial lesions in young patients with acute myocardial infarction. Khyber Medical University Journal, 10(2), 81–85. https://doi.org/10.35845/kmuj. 2018.17588
[28] Pandey, R., Maskey, A., Shrestha, B., Budhathoki, A., Malla, S. B., Baniya, B., Bhatta, S., Shrestha, S., & Yadav, P. K. (2021). Angiograhic profile and inhospital outcome of young patients presenting with ST elevation myocardial infarction (STEMI) in tertiary cardiac hospital. Journal of Advances in Internal Medicine, 10(2), 76–79. https://doi.org/10.3126/jaim. v10i2.42175
[29] Prakash, B., Jaiswal, A., & Shah, M. M. (2020). Demographic & angiographic profile of young patients aged 40 year & less undergoing coronary angiography in a tier II city of Eastern India. Journal of Family Medicine and Primary Care, 9(10), 5183–5187. https://doi.org/10.4103/jfmpc. jfmpc_1063_20 PMID:33409185
[30] Kumar, V., Kumar, T., Sharma, A. K., Nath, R. K., Sharma, L. K., Pandit, N., Raj, A., & Pandit, B. N. (2021). Risk factors, clinical presentation, angiographic profile and 30-day outcomes of young patients (aged≤ 35 Years) with ST-elevation myocardial infarction. Advances in Human Biology, 11(2), 188–194. https://doi.org/10.4103/aihb.aihb_125_20
[31] Qadir, A., Waseem, A., Wani, M. M., & Rather, H. A. (2022). Clinical and angiographic profile of acute myocardial infarction in young patients: A prospective 2 years study. International Journal of Clinical Biochemistry and Research, 9(2), 106–109. https://doi.org/10.18231/j.ijcbr.2022.021
[32] McCaughey, C., Kumar, R., Teehan, S., Gardiner, R., Kumar, J., Murray, C., Khan, B., & Murphy, G. (2021). 6 Demographic, clinical and angiographic profile of young adults (≤ 45 years) undergoing percutaneous coronary intervention for ST elevation myocardial infarction. Heart, 107(2), A6–A8. https://doi.org/10. 1136/heartjnl-2021-ICS.6
[33] Alfaddagh, A., Khraishah, H., Rashed, W., Sharma, G., Blumenthal, R. S., & Zubaid, M. (2020). Clinical characteristics and outcomes of young adults with first myocardial infarction: Results from Gulf COAST. International Journal of Cardiology. Heart & Vasculature, 31, 100680. https://doi.org/10.1016/j. ijcha.2020.100680 PMID:33304990