早发与非早发ST段抬高型心肌梗死多支血管病变患者的临床特点分析

Non-premature andpremature ST-elevation myocardial infarction （STEMI） patients with multivessel disease： risk factors and clinical features

目的探讨直接PCI处理的早发STEMI多支血管病变患者临床特点及危险因素。方法回顾性分析2005年1月至2015年1月于北京安贞医院住院期间诊断为STEMI并完成直接经皮冠状动脉介入治疗（PrimaryPCI，PPCI）的多支血管病变（MVD）的早发患者（男性〈55岁、女性〈65岁）371例，选取同时期住院发生STEMI并完成PPCI的MVD非早发患者662例作为非早发组。观察性别、吸烟史、冠心病家族史、高血压病、2型糖尿病、既往心肌梗死及血运重建、卒中史、血尿酸、血脂等与早发STEMI合并MVD的关系。并比较两组患者冠状动脉病变特点及院内不良事件的发生。结果（1）与对照组相比，早发组中男性（88．4％和76．9％）、吸烟者（74．9％和51．5％）、冠心病家族史[21．0％vs．9．7％]比例较高（P〈0．01），患者舒张压、总胆固醇、低密度脂蛋白胆固醇、甘油三酯、肌酐清除率、血小板计数及红细胞压积高于非早发组（P〈0．01），高密度脂蛋白胆固醇较低（P〈0．01）。（2）两组院内事件发生率均较低。早发组住院期间更少发生室性心动过速（0．3％和2．3％）（P〈0．01）。非早发组院内病死率更高（1．5％vs0．3％）（P〈0．01）。（3）两组问梗死相关血管，梗死部位，病变血管支数差异无统计学意义。（4）Logistic回归分析示，吸烟史（OR=2．22，95％CI：1．588～3．108）、冠心病家族史（OR=2．12，95％CI：1．431～3．140）、血甘油三酯浓度（OR=1．971，95％CI：1．475～2．635）、血低密度脂蛋白胆固醇浓度与早发STEMI多支病变的发生有关（OR=1．193，95％CI：1．008～1．413），均P〈0．05。结论吸烟史、冠心病家族史、血甘油三酯浓度、血低密度脂蛋白胆固醇浓度是早发STEMI合并多支血管病变的主要危险因素；相比早发患者，非早发患者住院期间较易发生室性心动过速；无论是否为早发患者，其冠状动脉病变特点没有显著差别。

Objective To investigate the clinical characteristics and risk factors of non-premature STEMI patients underwentprimaryPCI with multivessel disease. Methods Data of clinic and coronary angiographic features were retrospectively compared between group of 371 younger STEMI patients （male age 〈 55 years, female 〈 65 years ） and group of 662 older STEMI patients. All patients were admitted to hospital from January 2005 to January 2015 and treated with primary PCI. The patients＇ gender, smoking history, family history of coronary heart disease （CHD）, hypertension, type 2 diabetes mellitus, previous myocardial infarction and revascularization, stroke history, serum uric acid, lipids etc. were documented. The comparison of coronary artery disease characteristics and the incidence of adverse events during hospitalization were also carried out between two groups. Results （1） Prevalence of males （88.4% vs. 76. 9%）, smokers （74.9% vs. 51.5%）, family history of CHD （21.0% vs. 9.7%） and levels of diastolic blood pressure, total cholesterol, low density lipoprotein cholesterol （LDL-c）, triglycerides, andlow cholesterol were significantly higher in the non-prematuregroup than in the premature group （ all P 〈 0. 01 ）, while high density lipoprotein cholesterol （HDL-c） was lower in non-prematuregroup （P 〈 0. 01 ） . （2） The incidence of in-hospital events in both groups were low. There was less ventricular tachycardia in the non-premature group （ 1.5% vs. O. 3% ） （ P 〈 0. 05 ） . （ 3 ） There were no statistically significant differences in the number of infarct vessels, site ofinfarctbetween two groups. （4） Logistic regression analysis showed that smoking （OR=2.22, 95%CI： 1.588-3. 108） （P〈0.05）, family history of CHD （OR=2.12, 95%CI： 1.431-3.140） （P〈0.05）, triglyceride concentration （OR=1.971, 95%CI： 1.475-2.635） （P〈0.05）, LDL-c （OR=1.193, 95%CI： 1.008-1.413） （P=0.04） were independent risk factors fornon-premature STEMI withmultivessel disease. Conclusion Smoking, family history of CHD, triglyceride concentration, LDL are main risk factors of younger age STEMI patients with multiple vessel disease; Compared with younger age patients, older age patients during hospitalization are more likely to occur ventricular tachycardia. Regardless of age difference, the characteristics of coronary artery lesions show no significant difference.