青年人急性心肌梗死的危险因素、首发症状及冠状动脉造影特点分析

Coronary angiography and clinical features of acute myocardial infarction in young adults under years of age

目的：评价青年人急性心肌梗死的危险因素、首发症状及冠状动脉造影特点.方法：回顾分析62例年龄≤40岁（青年组）和508例40岁以上（对照组）急性心肌梗死患者的危险因素、首发症状及冠状动脉造影结果.结果：青年组男性、吸烟史、高脂血症及心血管病家族史均明显高于对照组（分别为95.2%对68.3%、77.4%对53.9%、50.0%对34.8%和40.3%对12.2%）,而既往心绞痛或心肌梗死史、糖尿病、高血压及脑卒中史均明显低于对照组（分别为3.2%对17.3%、8.1%对25.6%、14.5%对43.3%和0%对8.1%）;青年组典型胸痛率明显高于对照组（77.4%对 54.1%）,不典型胸痛及无胸痛率低于对照组（16.1%对28.3%和6.5%对17.5%）;青年组冠状动脉造影正常及轻度病变率明显高于对照组（6.3%对0.6%和12.5%对3.4%）,且以冠状动脉单支病变多见,冠状动脉多支病变率低于对照组（2.1%对18.0%）,经皮冠状动脉干预率高于对照组（ 77.4%对63.6%）.结论：男性、吸烟史、高脂血症及心血管病家族史是青年人急性心肌梗死的主要危险因素;青年人胸痛症状典型;以单支冠状动脉病变占多.

Objective, To evaluate infarction risk factors, initial symptoms and the characteristics of coronary angiography of the young with acute myocardial infarction（AMI）. Methods： Infarction risk factors, initial symptoms and the characteristics of coronary angiography were analyzed retro- spect!vely between the young patients group with AMI （age~〈40 years, n^62）and control group with AMI（age^40 years, n^508）. Results： Male gender, cigarette smoking, hyperlipoidemia and a family history of cardiovascular diseases were more prevalent in young patients group with AMI（95. 2% vs. 68.3~, 77.4% vs. 53.9Y0, 50.0% vs. 34.8%, 40.3% vs. 12.2~, respectively）, whereas the elderly patients were more likely to have prior angina pectorls or myocardial infarction, diabetes mellitus, hypertension and prior cerebrovascular accident（3.2% vs. 17.3%, 8.1% vs. 25. 6%, 14.5% vs, 43, 3%, 0% vs. 8.1%, respectively）. The percent of typical chest pain was higher in young patients group compared with control group （77.4% vs. 54. 1%）. The patients with atypical chest pain and patients without chest pain were found more prevalent in control group（16.1% vs. 28.3%, 6.5% vs, 17.5%, respectively）, The young patients had higher proportion of anglograph cally normal coronary artery, mild coronary disease and single--vessel disease（6.3% vs. 0.6%, 12. 5% vs. 3.4%, 60.4% vs. 40.2%, respectively）, whereas prevalence of multi--vessel disease in young group was obviously less than that of the control group（2. 1 % vs. 1 8.0 %）. The young patients were more likely to undergo percutaneous coronary intervention（77.4% vs. 63.6%）. Conclusion： Male gender, cigarette smoking, hyperlipoidemla and a family history of cardiovascular diseases were the most common risk factors among young patients with AMI. Most of them had typical symptom. Young patients had a higher fre- quency of single--vessel disease.