青年人急性心肌梗死40例分析

Acute myocardial infarction in youth patients——A report of 40 cases

目的 探讨青年人急性心肌梗死 (AMI)的临床和冠状动脉造影的特征。方法 总结 40例年龄 45岁以下AMI患者的临床资料 ,并对其冠状动脉造影进行分析。结果 40例青年人AMI占同期我院住院AMI患者的 5 .7%。患者的平均年龄为 40 (2 6～ 45 )岁。心电图表现前壁梗死 2 7例 (6 7.5 % )。 2 4例 (6 0 % )患者以AMI为冠心病的首发表现 ;16例 (40 % )既往有心肌缺血史 ,其中约半数病程在 1个月内 ;4例为再次出现心肌梗死。 2 6例 (6 5 % )有吸烟史 ;13例 (32 .5 % )血脂增高 ;9例 (2 2 .5 % )有高血压。 8例 (2 0 % )嗜酒。 8例 (2 0 % )有冠心病家族史。所有病例发病均以剧烈的心前区或胸骨后疼痛为首发症状。 2 8例 (70 % )AMI发病前有明显的诱因。 30例冠状动脉造影中 7例 (2 3.3% )冠状动脉正常 ,2 3例 (76 .7% )冠状动脉造影阳性 (狭窄 >5 0 % ) ;单支病变 11例 (47.8% ) ,2支病变 7例 (30 .4% ) ,3支病变 5例 (2 1.8% )。在所有 40支病变血管中 ,LAD占 5 5 % ,RA占 32 % ,LCX占 12 %。 8例成功行CABG术 ,2例PTCA术中 1例放置支架 ,1例失败。结论 本文表明 ,有部分青年人AMI患者冠状动脉造影显示正常 ,而少见弥漫病变的狭窄特征。

Objective To study the clinical presentations and features of coronary angiography in young patients with AMI. Methods The clinical data and findings of coronary angiography were analyzed in Forty cases of AMI,aged ≤45years.Results 40 cases of AMI accounted for 5.7% of total MI during the same period,37 males, 3 females,with a mean age of 40.1(26 45) years. The ECG showed anterior wall infarction in 27 cases(67.5%),inferior wall infarction in 7 cases (17.5%) and anterior plus inferior wall infarction in 6 cases(15%).Sixteen cases(40%) had had a history of cardiac ischemia previously,in which the history was less than one month in 7 cases,26 cases (65%) had a history of heavy smoking,13(32.5%) hyperlipidemia,9(22.5%) hypertension,8(20%) alcohol abuse and 8 (20%) family history of CHD. All patients with AMI presented with severe precordia pain during the acute attack.Twenty four cases(60%) with AMI occurred as the first clinical manifestation of CHD. In 30 cases underwent coronary angiography, normal or nonobstructive disease had been seen in 7 cases (23.5%),Obstuctive disease with more than 50% in diameter in 23 cases (76.5%), of which 47.8% were single vessel disease 21.8% 2 vessel disease and 30.4% 3 vessel disease. In total of 40 diseased arteries,LAD accounted for 55%,RCA32.5% and LCX12%.In treatment 8 patients were operated on CABG successfully,one underwent PTCA plus stent implantation, one PTCA was failed.Conclusion These data suggest that havy smoking as well as normal coronary artery is frequently seen in young patients with AMI, however, atherosclerosis of coronary artery is less extensive.