目的 分析青年急性心肌梗死(AMI)患者的临床特点及冠状动脉病变特征.方法 从2010年1月至2014年7月在武汉大学人民医院心内科住院诊断为AMI的患者中,选取年龄＜40岁且有完整冠状动脉造影资料的AMI患者64例作为青年组,选取同期年龄＞60岁且有完整冠状动脉造影资料的AMI患者236例作为老年组.统计患者基本临床资料及入院24 h内实验室检查结果、超声心动图及心电图检查,并记录患者住院期间心律失常、心力衰竭、心源性休克及心源性猝死等主要不良反应发生率.分析2组患者临床资料、危险因素(吸烟史、饮酒史、高胆固醇血症、高血压、糖尿病、家族史)以及冠状动脉造影结果.结果 ①青年组中男性、吸烟史、饮酒史及冠心病家族史患者比例高于老年组[87.5％ (56/64)比71.2％ (168/236)、65.6％ (42/64)比36.0％(85/236)、39.1％ (25/64)比25.8％(61/236)、35.9％(23/64)比11.0％(26/236)];高血压病史、糖尿病病史及肥胖比例低于老年组[17.2％ (11/64)比34.8％ (82/236)、12.5％(8/64)比27.1％(64/236)、14.1％ (9/64)比35.2％(83/236)](P＜0.05);②青年组总胆固醇和三酰甘油水平高于老年组[(5.4 ± 1.8) mmol/L比(4.4 ±2.7) mmol/L、(2.6±1.7) mmol/L比(1.4±1.3) mmol/L];青年组中1种危险因素者比例高于老年组[32.8％ (21/64)比19.5％(46/236)];无危险因素者和4种及以上危险因素者低于老年组[6.2％(4/64)比11.9％(28/236)、4.7％ (3/64)比9.3％(22/236)](P＜0.05);④青年组冠状动脉造影正常和单支血管病变所占比例高于老年组[9.4％ (6/64)比4.2％(10/236)、70.3％ (45/64)比40.7％(96/236)];罪犯血管位于左回旋支和右冠状动脉所占比例低于老年组[15.6％ (10/64)比29.7％(70/236)、31.2％(20/64)比40.2％(95/236)];冠状动脉狭窄程度积分低于老年组[(9±5)分比(17±7)分](P＜0.05).⑤青年患者亚组分析单支血管病变组心血管危险因素少于多支血管病变组[(1.6±0.6)个比(2.7±0.4)个](P＜0.05);⑥青年组中出现心力衰竭、心源性休克及死亡者低于老年组[18.8％(12/64)比27.1％(64/236)、9.0％ (6/64)比16.5％(39/236)、4.7％ (3/64)比6.8％ (16/236)](P＜0.05).结论 吸烟、饮酒及家族史是青年AMI的主要危险因素.青年AMI患者冠状动脉病变程度较轻,且病变范围较局限.青年AMI患者多支血管病变者较单支血管病变者有更多险因素,青年AMI患者心力衰竭、心源性休克及病死率较老年AMI患者低.%Objective To analyze the clinical characteristics and coronary angiographic feature in young patients with acute myocardial infarction(AMI).Methods The patients with acute myocardial infarction during January 2010 to July 2014 in renmin hospital of wuhan university were divided into two groups.64 consecutive patients ＜ 45 years of age with a diagnosis of acute myocardial infarction and had coronary angiography were assigned to the young group.We also selected 236 consecutive patients ＞ 60 years of age who had coronary angiography during the same time as the old group.The basic clinical data and laboratory results were collected within 24 h.The cardiac function tests were performed for all the patients during the period of hospitalization.The echocardiographic parameters were analyzed,meanwhile the electrocardiogram detection was performed.The incidence of major adverse cardiovascular events including malignant arrhythmia,heart failure,cardiogenic shock and sudden cardiac death during during the period of hospitalization was also observed and analyzed.The patient's cardiovascular history,results of risk factors(smoking,hypercholesterolemia,hypertension,diabetes mellitus,and family history) and coronary angiography of two groups were compared and analyzed.Results The young patients showed more male [87.5％ (56/64) vs 71.2％ (168/236)],more smoking history [65.6％ (42/64) vs 36.0％ (85/ 236)],more drinking history [39.1％ (25/64) vs 25.8％ (61/236)],and more family history [35.9％ (23/64) vs 11.0％ (26/236)] compared with the old patients.The prevalence of hypertension,diabetes mellitus,obesity were lower in the young patients[17.2％ (11/64) vs 34.8％ (82/236),12.5％ (8/64) vs 27.1％ (64/236),14.1％ (9/64) vs 35.2％ (83/236)] (P ＜ 0.05).The young patients had higher total cholesterol and triglyceride levels than the old patients [(5.4 ± 1.8) mmol/L vs (4.4 ± 2.7) mmol/L,(2.6 ± 1.7) mmol/L vs (1.4 ± 1.3) mmol/L] (P ＜0.05).The percentage of one risk factor [32.8％ (21/64) vs 19.5％ (46/236)] in young group was higher than that of the old group; the percentage of no-risk factors and four or more risk factors was lower than that in the old group [6.2％ (4/64) vs 11.9％ (28/236),4.7％ (3/64) vs 9.3 ％ (22/236)] (P ＜0.05).The percentage of normal coronary artery and single-branch lesion was higher in the young patients[9.4％(6/64) vs 4.2％ (10/236),70.3％ (45/64) vs 40.7％ (96/236)] (P ＜ 0.05).As culprit artery,the prevalence of left circumflex coronary artery and right coronary artery was lower in the young patients[15.6％ (10/64)vs 29.7％ (70/236),31.2％ (20/64) vs 40.2％ (95/236)].The degree of coronary artery stenosis [(9 ± 5) scores vs (17 ± 7)scores] was higher in the young patients(P ＜ 0.05).The average risk factors of young group in singe vessel disease [(1.6 ± 0.6) vs (2.7 ± 0.4)] were lower than in multi-vessel disease.The incidence of heart failure,cardiogenic shock and sudden cardiac death was lower in the young patients[18.8％ (12/64) vs 27.1％ (64/236),9.0％ (6/64) vs 16.5％ (39/236),4.7％ (3/64) vs 6.8％ (16/236)] (P ＜0.05).Conclusions Smoking,drinking and family history are the most common risk factors among young patients.The coronary artery stenosis severity and extension are less severe in young patients.In young patients,there are more cardiovascular risk factors in multi-vessel disease patients than in singe vessel disease patients.The incidence of major adverse cardiovascular events is lower in the young patients.
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