Acute coronary syndrome in young and middle-aged patients depending on the grade of coronary artery lesion

Introduction. Coronary artery disease (CAD), and acute coronary syndrome (ACS) in particular, remains the leading cause of mortality in Russia, resulting in significant socioeconomic losses. Beyond traditional risk factors, proinflammatory cytokine-related systemic inflammation and increased vascular stiff ness play a key role in the pathogenesis of adverse outcomes. Therefore, investigating the relationship between the activity of these processes, the severity of CAD, and the course of ACS in young and middle-aged patients represents a relevant and pressing, and understudied problem.

Aim. To assess the features of clinical presentation, the nature of systemic inflammation and vascular stiff ness indices in young and middle-aged ACS patients depending on the grade of coronary artery lesion.

Materials and methods . The study included 84 patients (64 men, 20 women) aged 37–60 years, hospitalized for myocardial infarction (MI) (22,6%) or unstable angina (77,4%). Based on the results of coronary angiography, patients were divided into two groups: with hemodynamically significant (>70%) – group 1 and intermediate (50–70%) or non-obstructive (<50%) coronary artery (CA) stenosis – group 2. All participants underwent testing for plasma interleukins (IL-1β, IL-6, IL-8, IL-4, and IL-10); besides, arterial stiff ness was assessed by measuring pulse wave velocity (PWV), vascular age, and cardio-ankle vascular index (CAVI).

 Results. Patients with hemodynamically significant CA stenoses (group 1) had a more severe CAD course: myocardial infarction, multivessel CAD, and percutaneous coronary interventions were significantly more common. Obesity and chronic kidney disease were also more common in this group. Patients in group 2 had higher IL-8 concentrations, while those in group 1 had higher IL-6 concentrations. Vascular stiff ness indices (PWV and CAVI) did not diff er significantly between the groups; however, a trend toward a lower vascular age compared to the chronological age was revealed in group 2.

Conclusion. Specific markers associated with the severity of CA lesion were identified in young and middle-aged patients with ACS. Patients with hemodynamically significant stenoses had a relative increase in IL-6 levels, while those with intermediate and non-obstructive stenoses had significantly elevated IL-8 levels.

1. Ralapanawa U., Sivakanesan R. Epidemiology and the magnitude of coronary artery disease and acute coronary syndrome: a narrative review. J. Epidemiol. Glob. Health. 2021;11(2):169-177. DOI: 10.2991/jegh.k.201217.001.

2. Usacheva E.V., Nelidova A.V., Kulikova O.M., Flyanku I.P. Mortality of Russian able-bodied population from cardiovascular disease. Hygiene and Sanitation. 2021;100(2):159-165. DOI: 10.47470/0016-9900-2021-100-2-159-165. (In Russ.)

3. Shcherbakova E.M. Demographic results of the first half of 2024 in Russia (part II). Demoscop Weekly. 2024;1045-1046. URL: https://demoscope.ru/weekly/2024/01045/barom01.php (accessed 10.09.2025).

4. Averkov О.V., Harutyunyan G.K., Duplyakov D.V. et al. 2024 Clinical practice guidelines for acute coronary syndrome without ST segment elevation electrocardiogram. Russian Journal of Cardiology. 2025;30(5):6319. DOI: 10.15829/1560-4071-2025-6319. (In Russ.)

5. Martynov A.Yu., Irkabaeva М.М., Politidis R.R. Myocardial infarction in young age. Russian Journal of Preventive Medicine. 2024;27(11):77-84. DOI: 10.17116/profmed20242711177. (In Russ.)

6. Karetnikova V.N., Neeshpapa A.G., Peganova Kh.A. Traditional and non-traditional risk factors for myocardial infarction in young adults. Russian Medical Inquiry. 2024;8(1):26-30. DOI: 10.32364/2587-6821-2024-8-1-4. (In Russ.)

7. Wang H., Liu Z., Shao J. et al. Immune and infl ammation in acute coronary syndrome: molecular mechanisms and therapeutic implications. J. Immun. Res. 2020;2020: 4904217. DOI: 10.1155/2020/4904217.

8. Shalnev V.I. Acute coronary syndrome: how to reduce the residual infl ammatory risk? Russian Journal of Cardiology. 2020;25(2):3720. DOI: 10.15829/1560-4071-2020-2-3720. (In Russ.)

9. Gostimskiy V.A., Vasilenko V.S., Kurnikova Е.А. et al. Cytokine status in middle-aged men with acute coronary syndrome after coronary artery stenting. Pediatrician (St. Petersburg). 2021;12(2):5-12. DOI: 10.17816/PED1225-12.

10. Casarotti A.C.A., Teixeira D., Longo-Maugeri I.M. et al. Role of B lymphocytes in the infarcted mass in patients with acute myocardial infarction. Biosci. Rep. 2021;41(2):BSR20203413. DOI: 10.1042/BSR20203413.

11. Gapon L.I. Hypertension and arterial wall stiff ness in clinical practice: literature review. Russian Journal of Cardiology. 2024;29(5):5924. DOI: 10.15829/1560-4071-2024-5924. (In Russ.)

12. Gao L., Lu D., Xia G., Zhang H. The relationship between arterial stiff ness index and coronary heart disease and its severity. BMC Cardiovasc. Disord. 2021;21(1):527. DOI: 10.1186/s12872-021-02350-6.

13. Nosov А.Е., Gorbushina О.Yu., Vlasova Е.М., Alekseev V.B. Prognostic signifi cance of arterial stiff ness parameters in the identifi cation of very high-risk patients. Kardiologiia. 2020;60(10):27-32. (In Russ.)