686 Coronary lesion distribution in young patient presenting with acute coronary syndrome

Aims The distribution of coronary lesions in young patients presenting with acute coronary syndrome (ACS) is not known. Methods and results We included 82 consecutive young patients (≤45 years at presentation) with ACS and obstructive coronary artery disease referred from October 2013 until March 2021 to our clinic. Significant coronary lesions (>50%) at each segment during coronary angiography were evaluated. A total of 158 lesions have been evaluated. Multivessel disease was observed in 37% of patients. Lesions at proximal and mid left anterior descending (LAD) coronary artery were the most common observation (Figure A). Roughly one in three lesions affected a proximal coronary segment (i.e. segment 1, 5, 6, or 11), and 45.1% of patients presented at least one lesion in these segments. Within each segment, lesions affected the ostium in 15.8%, proximal third in 26.8%, mid-third in 32.9%, and distal-third in 15.9% of cases. Among those presenting with ST-segment elevated myocardial infarction, culprit lesion distribution is presented in Figure B. Proximal segments were affected in 33.9%, while culprit lesion of the LAD, left circumflex, and right coronary artery was observed in 51.8%, 16.1%, and 32.1% respectively. Conclusions In conclusion, coronary artery disease in patients presenting with ACS occur more often in the LAD and in proximal coronary segments. A significant lesion in a proximal coronary segment affected roughly half of young patients presenting with ACS.