早发冠心病急性心肌梗死的危险因素及临床特点分析

Premature Coronary Artery Disease with Acute Myocardial Infarction:Risk Factors and Clinical Characteristics

目的探讨早发冠心病急性心肌梗死(AMI)的危险因素、临床特点和冠状动脉造影(CAG)特点。方法收集经CAG确诊的AMI患者504例,按发病年龄分为早发组(男≤55岁,女≤65岁)288例和晚发组(男>55岁,女>65岁)216例,对比分析早发组的心血管病危险因素、临床特点和冠状动脉病变特点。结果 (1)早发组患者以男性为主;多超重;吸烟史、饮酒史、高脂血症、阳性家族史明显多于晚发组(均P<0.05);晚发组患者中原发性高血压检出率高于早发组(P<0.05),糖尿病检出率也明显高于早发组(P<0.01)。(2)早发组TG水平明显高于晚发组,舒张压、高密度脂蛋白胆固醇水平明显低于晚发组(均P<0.05)。(3)早发组患者以单支病变为主,前降支最易受累,左主干较少受累,但死亡率高。(4)多因素Logistic回归分析显示吸烟史、阳性家族史、高TG、高血压、糖尿病等是早发冠心病AMI的独立危险因素。结论吸烟、饮酒、阳性家族史、以TG升高为主的脂质代谢紊乱等是早发冠心病AMI的主要危险因素;早发组患者的主要临床特点为男性所占比例高,高血压、糖尿病发生率低,CAG病变部位早发冠心病AMI患者病变多以单支病变为主,三支血管及左主干病变、严重、弥漫性病变少见,但累及左主干病变死亡率高。

Objective To analyze the risk factors,clinical characteristics,and coronary artery angiographic（CAG） features of premature coronary artery disease（PCAD）with acute myocardial infarction（AMI）.Methods Totally 504 patients with CAG-confirmed AMI were divided into premature AMI group（male≤55 years old,female≤65 years old,n=288）and mature AMI group（male55 years old;Female65 years old,n=216）.The relationship among risk factors,clinical characteristics,and features of coronary artery lesions were analyzed.Results The premature AMI group was male dominated,most of whom were over-weight.Compared with the mature AMI group,the premature AMI group had significantly more patients with histories of smoking,alcoholism,higher triglyceride（TG）levels,and positive family history（allP〈0.05）.The incidences of essential hypertension and diabetes were significantly higher in the mature AMI group than in premature group（P〈0.05,P〈0.01,respectively）.TG level in the premature group was significantly higher than that in mature group,while the levels of diastolic pressure and high density lipoprotein cholesterol were significantly lower（allP〈0.05）.Premature AMI were more likely due to single-vessel diseases.CAG also showed that the left anterior descending artery was the most commonly involved infarct related artery;fewer left main artery was involved in premature AMI group,but was associated with higher mortality.Multivariate analysis showed smoking,positive family history,high TG,hypertension,and diabetes were the independent risk factors for premature AMI.Conclusion Smoking,drinking,positive family history,and high TG were major risk factors for premature AMI.The main clinical characteristics of premature AMI are male-dominated and low incidences of hypertension and diabetes.Premature AMI are featured by more single-vessel lesions,less lesions at three vessel and left main artery,and fewer severe,diffuse lesions;nevertheless,lesions at left main artery are often associated with high mortality.