Young patient of 24 years old, smoker, dyslipidemic and family history of coronary artery disease (CAD). He was admitted to emergency room for chest pain after moderate effort in December. EKG was normal, troponin was negative and echocardiography showed left ventricle with normal contractility. Blood chemistry test showed LDL 130 mg/dL, Triglycerides 200 mg/dL e Lipoprotein (a) 16 nmol/L. Elective cardiovascular exercise test resulted positive for signs and symptoms of cardiovascular ischemia (Figure 1). Coronary angio-TC showed 60% stenosis of proximal LAD and intramyocardial bridging of mid LAD. Subsequently elective coronary angiography confirmed the description of coronary angio-TC; contextually optical coherence tomography (OCT) was performed and showed fibrous cap rupture of proximal LAD (Figure 2 – 3). The patient was discharged with indication of medical therapy (Cardioaspirina 100 mg, Atorvastatina 40 mg, Bisoprololo 1,25 mg).
CAD is a chronic condition usually occurring after the sixth decade of life. However, some populations experience this disease prematurely. In the last few decades, different studies have shown an increased incidence of CAD in very young people. The prevalence of CAD reported in very young people is 1-16%. Clinical and interventional management of CAD in very young people is still subject of discussion today. The literature showed how risk factors such us current smokers, dyslipidemia, and family history of CAD are significantly associated with the existence of severe CAD in patients of <40 years. The above risk factors are present in this patient, therefore we opted for correct them by medical therapy and follow-up by OCT at 6 months. The patient was stable and asyntomatic for chest pain at 1 month telephone follow-up.
