早发急性冠脉综合征患者的临床特点和预后分析

Clinical characteristics and prognosis in patients with premature acute coronary syndrome

目的探讨早发急性冠脉综合征(PACS)患者的危险因素、冠脉病变特点和预后情况。方法选取经冠状动脉造影(CAG)术确诊的急性冠脉综合征(ACS)患者132例,根据年龄分为两组,男性年龄≤55岁、女性年龄≤65岁者60例作为PACS组,而男性年龄>55岁、女性年龄>65岁者72例为对照组。统计两组人群基本临床资料,比较其冠脉病变特点和预后情况,并采用多因素logistic回归分析PACS的危险因素。结果 (1)PACS组有较明确的发病诱因,其男性比例、吸烟率、早发冠心病(PCHD)家族史、肥胖比例以及低密度脂蛋白胆固醇(LDL-C)水平均高于对照组(P<0.05),而对照组患者高血压、糖尿病比例明显高于PACS组(P<0.05);(2)PACS组冠状动脉病变支数、Gensini积分与对照组比较有明显差异(P<0.05),两组罪犯血管分布差异无统计学意义(P>0.05);CAG术还发现PACS组以冠脉单支病变和局限性病变为主(P<0.05)。(3)多因素Logistic回归分析显示,男性、吸烟、PCHD家族史比例以及LDL-C水平是PACS的独立危险因素;(4)院外随访6个月,PACS组的主要心血管不良事件(MACE)发生率明显低于对照组(P<0.05)。结论男性、吸烟、PCHD家族史及LDL-C是PACS患者的主要危险因素,改变不良生活方式、控制体重对PACS的发病及预后具有重要的意义。

Objective To investigate the risk factors,features of the coronary artery lesions and prognosis in patients with premature acute coronary syndrome（ PACS）. Methods A total of 132 patients with coronary angiography confirmed acute coronary syndrome（ACS） were assigned into PACS group（ male ≤ 55 years old,female ≤ 65 years old,n = 60） and control group（ male ﹥ 55 years old,female ﹥ 65 years old,n = 72）. The basic clinical data were collected to compare the characteristics of coronary artery lesions and prognosis. Meanwhile multivariable logistic regression was used to analyze the risk factors of PACS. Results（ 1） Compared with control group,more predisposing factors were found in PACS group. The ratios of male,smoking,family history of premature coronary heart disease（ PCHD）,obesity,and low-density lipoprotein cholesterol（ LDL-C） level were also significantly higher in PACS group than those in control group. However,the incidences of hypertension and diabetes were less in PACS group than those in control group（ P〈0. 05）.（ 2） The numbers of coronary lesions,Genisini score in PACS group were significantly different from those in control group（ P〈0. 05）,and there was no significant difference in the culprit vessel position（ P〈0. 05）. Furthermore,CAG identified higher incidence of single-vessel and local vessel lesions in PACS group（ P〈0. 05）.（ 3） Multiple factor logistic analysis revealed that male,smoking,history of PCHDand LDL-C levels were independent risk factors of PACS.（ 4） During the six-month follow-up period,the occurence of major adverse cardiac event（ MACE） in PACS group was significantly lower than that in control group. Conclusions Male,smoking,history of PCHD and LDL-C levels are major risk factors in PACS. Changing unhealthy lifestyle and weight controlmay have important significance in morbidity and prognosis of PACS.