40岁以下不同性别青年急性心肌梗死患者的临床特点及院内和远期预后分析

Clinical Features With In-hospital and Long-term Prognosis of Acute Myocardial Infarction in Patients Younger Than 40 Years by Different Genders

目的：分析40岁以下不同性别青年急性心肌梗死（AMI）患者的临床特点,住院期间和远期预后及不良事件的预测因素。方法：连续入选2012-01-01至2015-08-31在北京安贞医院确诊为AMI的青年（年龄≤40岁）患者685例,依据性别将患者分为两组,男性组650例,女性组35例。收集比较两组患者的基线资料、临床特征、住院期间不良事件发生情况,对所有患者进行电话随访,记录分析远期主要不良心血管事件（MACE）发生情况及危险因素。结果：男、女性组患者比例分别94.89%和5.11%;男性组平均年龄高于女性组[（35.53±4.21）岁vs（34.05±4.98）岁,P=0.046],男性组冠状动脉左主干病变比例（3.2%vs 11.4%,P=0.012）、院内急性心力衰竭发生率（8.3%vs25.7%,P=0.001）均低于女性组。随访时间中位数（四分位数）727.0（411.5,1 102.0）天,男性组有46例（7.1%）发生MACE事件,女性组为2例（5.7%）,差异无统计学意义（P=0.758）。超敏肌钙蛋白I水平升高[比值比（OR）=1.003,95%可信区间（CI）：1.001～1.006,P=0.020）和冠状动脉多支血管病变（OR=1.964,95%CI：1.018～3.790,P=0.044）是青年男性患者远期MACE的独立预测因素;经皮冠状动脉介入治疗（PCI,OR=0.475,95%CI：0.241～0.936,P=0.031）是男性患者远期预后的保护因素。结论：40岁以下青年AMI患者以男性为主;男性平均年龄大于女性,女性患者左主干病变比例更高,住院期间更易发生急性心力衰竭;超敏肌钙蛋白I水平升高、冠状动脉多支血管病变增加青年男性MACE发生率,而PCI对男性患者预后有利。

Objective：To evaluate clinical features with in-hospital and long-term prognosis of acute myocardial infarction（AMI） in patients ≤40 years of age by different genders and to analyze the predictors for major adverse cardiovascular event（MACE） occurrence.Methods：A total of 685 AMI patients ≤40 years treated in our hospital from 2012-01-01 to 2015-08-31 were consecutively enrolled.The patients were divided into 2 groups by gender：Male group,n=650 and Female group,n=35.The baseline data,clinical features,in-hospital MACE incidence were collected by telephone communication and compared between 2 groups;the long-term risk factors for MACE occurrence were analyzed.Results：The AMI ratio in male patients was 94.89%,in female was 5.11% and the onset age in Male group was higher than Female group（35.53±4.21） years vs（34.05±4.98） years,P=0.046.Compared with Female group,Male group showed the lower rates of coronary left main diseases（3.2% vs 11.4%,P=0.012） and in-hospital heart failure（8.3% vs 25.7%,P=0.001）.The median follow-up time was of 727.0（411.5,1102.0） days and during that period,MACE occurrence rates in Male group was 46（7.1%） cases and in Female group was 2（5.7%） cases,P=0.758.Increased level of hs-Tn I,（OR=1.003,95% CI 1.001-1.006,P=0.020） and multi coronary artery disease（OR=1.964,95% CI 1.018-3.790,P=0.044） were the independent predictors for long-term adverse event occurrence;while PCI（OR=0.475,95% CI 0.241-0.936,P=0.031） was the protector for long-term prognosis in young male AMI patients.Conclusion：AMI patients≤40 years were mainly in male gender,the mean onset age in male was elder than female.Increased hs-Tn I level and multi coronary artery disease were the predictors for MACE occurrence,while PCI was the protective factor for longterm prognosis in young male AMI patients.