青年ST段抬高型心肌梗死患者行直接经皮冠状动脉介入治疗的短期及长期结局

Short-and long-term outcomes of primary percutaneous coronary intervention in young patients with ST-elevation myocardial infarction

目的本研究旨在探讨青年ST段抬高型心肌梗死(ST-elevation myocardial infarction,STEMI)患者行直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PPCI)的短期及长期结局。方法选择2007年1月—2017年1月1 647例行PPCI的STEMI患者。根据患者行PCI时的年龄,将患者分为青年组(年龄≤55岁)302例和中老年组(年龄>55岁)1 345例。回顾性地分析2组患者的短期及长期结局。结果从2007至2017年,青年组患者呈现逐年增多的趋势。与中老年组患者相比,青年组患者的男性比例较高,吸烟、肥胖比例较高及冠心病家族史的比例较高;青年组患者高血压病、高脂血症、糖尿病、既往MI史等要低于中老年组。青年组患者的入院30 d内死亡率及主要不良心血管事件(major adverse cardiovascular events,MACE)低于中老年组。长期随访结果表明,青年组患者的生存率及无主要不良心血管事件生存率均高于中老年组。结论本研究表明,青年STEMI患者近10年来呈现增多的趋势,青年STEMI患者以男性居多,且肥胖及吸烟比例较高,其短期及长期结局较佳。积极减肥和控烟有望降低青年STEMI的发生率。

Objective To investigate short-and long-term outcomes of primary percutaneous coronary intervention（ PPCI） in young patients with ST-elevation myocardial infarction（ STEMI）. Methods From January,2007 to January,2017,a total of 1 647 patients with STEMI underwent PPCI at our hospital. Based on age when PPCI was performed,patients were divided into young（ ≤55 years） and middle-elderly（ 〉55 years） groups. Retrospective analysis of shortand long-term outcomes of these two patient groups was conducted. Results The study population included 302 patients in the young group and 1 345 patients in the middle-elderly group. During the study period,the number of young patients with STEMI tended to increase annually. Compared with the middle-elderly patients,the young patients more often were male,smokers,and obese,and had a family history of coronary heart disease. However,hypertension,hyperlipidemia,diabetes,and history of previous MI occurred less frequently in the young group than in the middle-elderly group. Thirtyday mortality and incidence of major adverse cardiovascular events（ MACE） also were lower in young patients. Long-term follow-up results showed that both overall and MACE-free survival were higher in young patients. Conclusion In summary,number of young patients with STEMI increased over the past decade,and these patients tended to be male,smokers,and/or obese,but had better short-and long-term outcomes. Hence,active weight loss and smoking cessation may be expected to reduce incidence of STEMI among young people.