青年心肌梗死患者临床特点和住院期转归

目的评价青年心肌梗死患者临床特点、住院期间不良事件和病死率。方法入选我院2002年1月至2007年12月初发ST段抬高型心肌梗死患者614例,按照患者年龄分为青年组(23～44岁,96例)和老年组(60～74岁,518例),将两组临床特点(包括性别、年龄、吸烟、化验指标、并存疾患)、危险因素分布、住院并发症和病死率进行比较。结果 (1)青年组与老年组比较,早发心血管病家族史(13.0%比5.6%,P=0.021)、吸烟(82.3%比42.1%,P<0.001)、高三酰甘油血症(56.7%比34.9%,P<0.001)者比例均增高,女性(4.2%比34.4%,P<0.001)、脑血管病(1.1%比15.3%,P<0.001)、血肌酐[(93.7±8.8)μmol/L比(104.3±61.9)μmol/L,P<0.001]均减低,具有多重危险因素的患者比例(40.1%比29.0%,P<0.05)高于老年组;(2)冠状动脉造影显示,青年组以单支病变为主,多支病变的比例明显低于老年组;(3)青年组住院期间无心源性休克及死亡病例。结论吸烟和高脂血症是青年心肌梗死患者最常见的危险因素,青年心肌梗死患者冠状动脉病变较轻,短期预后较好。

Clinical characteristics and in-hospital outcome among young patients with acute myocardial infarction

Objective To investigate clinical characteristics and in-hospital mortality in young patients with acute myocardial infarction. Methods The 614 patients with ST elevated myocardial infarction were divided into young group （23-44 years, n = 96） and elderly group （60 -74 years, n = 518）. Comparison was made on clinical characteristics （gender, smoking, chemical examination, comorbidity） , risk factors, complications and in-hospital mortality. Results （ 1 ） Compared with elderly group, young group had less female patients （4.2% vs. 34.4% , P 〈0.001） and less cerebral vascular disease （ 1.1% vs. 15.3% , P 〈0. 001 ）. The prevalences in family history of early onset cardiovascular disease （13.0% vs. 5.6%, P=0.021）, hyperlipidemia （56. 7% vs. 34.9%, P〈0.001）, smoking （82. 3% vs. 42. 1%, P〈 0. 001 ） and multiple risk factors （40. 1% vs 29. 0%, P =0. 021 ） were higher in young group than in elderly group. （2） Most young patients had single vessel disease according to coronary augiography. （3） Tt, ere were no cardiogenic shock and in-hospital death occured in young group. Conclusions Smoking and hyperlipidemia are the most common risk factors for young patients with acute myocardial infarction. In-hospital outcome of these patients is relatively better than elderly patients.