Acute coronary syndromes in young patients and thrombophilia : the experience of our hospital

Type of funding sources: None.

The number of young patients presenting with acute coronary syndromes is increasing. Among them, there is a large number of patients without major cardiovascular risk factors raising concerns about the cause of the acute coronary syndrome. It is known that thrombophilia is an independent risk factor for myocardial infarction.

To evaluate the frequency of thrombophilia in young patients presenting with acute coronary syndrome.

We performed genetic testing for the most frequent gene mutations responsible for thrombophilia (factor V Leiden, PAI I 4G/5G, prothrombin G20210A, MTHFR C677T, MTHFR A1257C, MTHFR A1298C) in all patients presenting with acute coronary syndrome that were aged <40 (men) or <45 (women), for a period of 10 years.

We recorded 127 patients , 114 (89.76%) male and 13 (10.23%) female. Their mean age was 36±1.7years.Regarding the conventional cardiovascular risk factors, 67/127(52.75%) were smokers, diabetes mellitus was present in 26/127(20.47%), arterial hypertension in 12/127(15.24%), positive family history in 92/127(72.44%) and dyslipidemia in 79/127(62.2%).The genetic testing was positive for thrombophilia in 109/127 (85.82%). 25/109 (22.93%) were factor V Leiden homozygotes, 11/109 (10.09%) factor V Leiden heterozygotes, 17/109(15.59%), PAI I 4G/5G homozygotes, 8/109 (7.33%) PAI I 4G/5G heterozygotes, 36/109 (39.24%) G20210A homozygotes and 12/109 (13.08%) G20210A heterozygotes.

Thrombophilia seems to be present in the majority of young patients presenting with acute coronary syndrome and should not be overlooked. More studies are needed t identify whether the presence of thrombophilia affects the prognosis of these patients as well as whether is necessary a different approach in their treatment and management.