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青年ST段抬高心肌梗死患者临床、冠脉造影特点及预后分析
Analysis of myocardial infarction in young adults: clinical risk factors, angiographic findings and prognosis

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DOI:
作者:
姚康
Yao Kang，Zhang Shuning，Ge Lei，Qian Juying，Ge Junbo
作者单位:
复旦大学附属中山医院
Department of Cardiology, Zhongshan Hospital；Shanghai Institute of Cardiovascular Diseases, 180 Fenglin Road, Shanghai China
关键词:
青年；冠心病；ST段抬高心肌梗死；危险因素
young adult; ST-segment elevation myocardial infarction; coronary artery disease; risk factors
摘要:
目的：青年ST段抬高心肌梗死可能与老年患者存在较大差别。我们探讨了40岁及以下青年ST段抬高心梗患者的临床发病特点、危险因素特征、冠状动脉病变特点及其预后。方法：回顾性分析自2005年5月至2010年5月在我院接受直接PCI的ST段抬高急性心梗患者，按照年龄段分为：青年组（≤40岁），中年组（41-59岁）和老年组（≥60岁）。分析其危险因素特点、冠脉造影特点、介入治疗情况及12个月的预后。结果：五年期间我院接受直接PCI的青年心梗患者占所有ST段抬高心梗患者的2.2％。青年心梗男性比例最高(95.0％)，吸烟及冠心病家族史的比例也高于其它年龄组（p<0.001），病变累及以单支病变为主（青年组65.0%，中年组24.8%，老年组20.6%，p<0.001），罪犯血管以前降支最为多见（青年组73.7％，中年组57.5％，老年组45.1％，p<0.001），三组介入治疗成功率无明显差别，青年心梗住院期间及12个月随访的严重心力衰竭发生率显著低于中老年组，虽然死亡率三组无统计学差异，但12个月随访时的主要心脏事件在年轻组显著低于中、老年组（p=0.02）。结论：青年心肌梗死患者临床危险因素特征、冠状动脉病变特点及其预后方面与老年患者存在较大差异，心脏功能及主要心脏事件等远期预后较好。
Objective: To evaluate the similarities and dissimilarities, including clinical characteristics, angiographic features, in-hospital and long-term outcomes, among younger and older patients with ST-segment elevation myocardial infarction (STEMI). Methods: From May 2005 to May 2010, database of 892 consecutive STEMI patients referred to our hospital and underwent primary percutaneous intervention (PCI) were analyzed．Young adult patients aged 40 years or below were identified (n=20). They were then compared with their older counterparts: middle aged group (41-59years, n=327) and older groups(≥60years, n=545). Data of clinical cardiovascular risk factors, demographic features, angiographic findings as well as in-hospital and 12 months outcomes were gathered and analyzed. Results: During the 5 year period, 2.2% of STEMI patients admitted to our hospital were 40 years or less. Predominant male patients were found in these young adults (95.0％). Smoking and positive family history for coronary artery disease were more prevalent in the younger group ( p<0.001). Incidence of single vessel lesion (65.0%，24.8%，20.6%，p<0.001）, particular left anterior descending, was significantly higher in the younger group(73.7％,p<0.001) when analyzed angiographic involvement. Compared with middle aged and older patients, the young patients had significantly lower incidence of in-hospital and 12 months advanced heart failure (in-hospital: p=0.008; 12 months p= 0.02). Conclusion: These results suggest that the risk factor profile, angiographic involvement differ considerably among younger and older patients. Young adults who underwent primary PCI have favorable in-hospital and long-term outcomes.

 

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