青年急性心肌梗死患者诊治策略的选择(附36例报告)

目的 结合青年急性心肌梗死(AMI)患者的发病特点,探讨其诊治策略的选择。 方法 回顾2006年12月至2012年1月入院的36例青年AMI和1 283例中老年AMI患者的住院病例资料,分析其危险因素、临床特征和诊治策略。 结果 (1)青年AMI占AMI患者的2.7%,男性占绝大多数(35/36,97.2%),以ST段抬高型心肌梗死为主(34/36,94.4%),常存在吸烟、血脂异常等危险因素,合并高血压、糖尿病等危险因素者较少。青年AMI患者发病后心源性休克、心力衰竭、心律失常者分别占5.6%(2/36)、16.7%(6/36)、5.6%(2/36),无院内及随访期间死亡病例。(2)33例进行冠脉造影的青年AMI患者中,单支病变占63.6%(21/33),最常累及前降支,前壁心肌梗死多见。在行急诊冠状动脉造影的15例患者中,6例(40%)患者血栓负荷重,但冠脉狭窄不重,未急诊置入支架。 结论 对于吸烟、血脂异常、有胸痛症状的青年男性,应注意AMI的可能。青年AMI多为单支病变,预后相对较好,需及时进行血运重建。

Choice of diagnostic and therapeutic strategy for young patients with acute myocardial infarction: a report of 36 cases

Objective To study the choice of diagnostic and therapeutic strategy for young patients with acute myocardial infarction (AMI) according to the onset characteristics. Methods We retrospectively analyzed the clinical data of 36 young and 1 283 elderly patients with AMI, who were treated between Dec. 2006 and Jan. 2012 in our hospital. The risk factors, clinical characteristics and diagnosis/treatment strategies were analyzed. Results (1) The young patients accounted for 2.7% of all the AMI patients in our study, with most of them being male (97.2%). AMI with ST-segment elevation accounted for 94.4% (34/36) among the young AMI patients, often with risk factors like smoking and dyslipidemia, scarcely with hypertension or diabetes. In the young patients the incidence rates of cardiogenic shock, heart failure and arrhythmia were 5.6% (2/36), 16.7% (6/36), and 5.6% (2/36, respectively, and there was no death during treatment or follow-up. (2) Among the 33 young patients receiving coronary angiography, 21 (63.6%) had single vessel lesions, mostly involving the left anterior descending artery and resulting in anterior myocardial infarction. Among the 15 young AMI patients who received emergent coronary angiograpy, 6 (40%) had heavy thrombus burdern but had slighter coronary stenosis, and they did not receive stent treatment. Conclusion AMI should be considered when young male patients with smoking history, dyslipidemia and chest pain. Young AMI patients often have single vessel lesions and better prognosis, and they need timely revascularization.