摘要
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.
出处
《中国循环杂志》
CSCD
北大核心
2016年第10期976-980,共5页
Chinese Circulation Journal
基金
国家高技术研究发展计划(2015AA020102)
北京市自然科学基金资助项目(7141003)
首都临床特色应用研究(Z141107002514014)
关键词
心肌梗死
青年
不良事件
预后
Acute myocardial infarction
Youth
Adverse events
Prognosis