青年初发急性心肌梗死患者心肌梗死类型及危险因素变化趋势分析

目的:分析青年(18～44岁)初发急性心肌梗死(AMI)患者心肌梗死类型及危险因素变化趋势.方法:收集2007年1月至2017年12月我院18～44岁初次诊断为AMI的住院患者.通过电子病历系统提取患者年龄、性别、出院诊断等一般临床资料,高血压病史、糖尿病病史、高胆固醇血症、肥胖、吸烟和饮酒6项心血管疾病可改变危险因素...

Trends and Subtypes of Acute Myocardial Infarction and Modifiable Risk Factors in Chinese Young Adults Hospitalized With First Acute Myocardial Infarction

Objectives:This study aimed to estimate the temporal trends and subtype of acute myocardial infarction(AMI)and association with modifiable risk factors of cardiovascular disease in Chinese young adults hospitalized with first AMI.Methods:This was a retrospective cohort analysis based on medical records from Beijing Anzhen hospital from January 2007 to December 2017.Hospitalized young adults(18 to 44 years)for first AMI were identified.Demographic and clinical data(gender,age and discharge diagnosis),modifiable cardiovascular risk factors(hypertension,diabetes,hypercholesterolemia,obesity,smoking and drinking)were analyzed,and coronary angiography findings were reviewed by experienced cardiologists.Results:This study included 2866 young adults with first AMI(male,n=2739,female,n=127),the mean age was(38.9±4.7)years.Smoking(2084[72.7%]),hypertension(1170[40.8%])and obesity(1084[37.8%])were most prevalent.Presentation of AMI was more frequently ST-segment elevation myocardial infarction(STEMI,77.3%,2214/2866).Non-ST segment elevated myocardial infarction(NSTEMI)showed an increasing trend,proportion of NSTEMI increased from 9.2%to 36.9%between 2007 and 2017(rate difference 27.7%,P_trend<0.001).NSTEMI patients had a higher prevalence of hypertension,diabetes,hypercholesterolemia and obesity,and lower prevalence of coronary single vessel disease as compared to STEMI patients(all P<0.05).Logistic regression analysis showed that multiple metabolic risk factors significantly increased the risk of NSTEMI(OR=1.39,95%CI:1.20-1.60),patients with multi-vessel coronary disease(OR=1.27,95%CI:1.05-1.54)and patients without significant coronary stenosis or normal patients(OR=2.15,95%CI:1.59-2.90)faced much higher risk of NSTEMI compared with those with coronary single vessel disease.The prevalence of multiple metabolic risk factors increased and coronary single vessel disease decreased significantly from 2007 to 2017(all P_trend<0.05).Conclusions:Proportion of young adults with first AMI is significantly higher in males than in females.The presentation of AMI is more frequently STEMI,but prevalence of NSTEMI increases over time.Observed trends changes are associated with changes on the multiple metabolic risk factors and characteristic of coronary artery disease in young adults suffering from first AMI.