年轻急性心肌梗死的临床特征和预后分析

摘要

目的：探讨年轻急性心肌梗死(≤40岁)患者的危险因素、冠状动脉病变特征、临床特点及预后情况。方法选择年龄≤40岁的年轻心肌梗死患者22例作为年轻组，随机选取同期年龄>40岁且完成冠脉造影的心梗患者46例为对照组。分析两组患者的危险因素、冠状动脉病变特征、临床特点及近期预后。结果年轻组患者严重吸烟史、高胆固醇血症、冠心病家族史及肥胖比例均高于对照组患者(P<0.05)，而对照组患者原发性高血压、糖尿病比例明显高于年轻组患者(P<0.05)。年轻心梗患者冠状动脉造影单支病变者明显高于对照组患者(P<0.01)，而多支受累者在对照组患者中多见(P<0.01)。年轻组患者心肌梗死发作较对照组有更高的明确诱因、典型胸痛症状及STEMI心电图征象。与对照组相比，年轻患者严重心脏事件及死亡率均明显低于对照组患者(P<0.05)。结论吸烟、高胆固醇血症、冠心病家族史及肥胖是年轻心梗的主要危险因素；与老年患者相比年轻心梗具有更典型的临床症状及心电图特征，且单支病变较多，预后较老年患者佳。%Objective To investigate the risk factors,clinical feature,the results of coronary angiography(CAG) and prognosis in young patients with acute myocardial infarction( AMI) . Methods Twenty-two patients ( younger than 40 years old) with acute myo-cardial infarction were collected as young group. AMI patients whose ages were older than 40 years old were collected as control group. The data of the risk factors, clinical feature and coronary angiography and prognosis were collected and analyzed between the two groups. Results The young patients had higher ratio of smoking,total cholesterol,obese and family history (P<0. 05). However,the ratios of hypertension and diabetes mellitus in young patients were less than those in old patients (P<0. 05). Coronary angiography in-dicated the young patients had more normal or single-vessel diseases while the older patients had more multi-vessel diseases ( P <0. 01). The younger patients had more risk factors,more typical stethalgia and more had STEMI than the old patients (P<0. 01). Com-pared with control group,the patients had lower severe adverse events and mortality in young group (P<0. 05). Conclusions Com-pared with old patients,smoking,total cholesterol,obese and family history are major risk factors in younger patients. However,young patients have more typical clinical and electrocardiogram feature and better prognosis than the old ones.