不同年龄段男性急性ST段抬高型心肌梗死患者临床特征的对比分析

Contrastive Analysis on Clinical Features in Male ASTEMI Patients with Different Age Groups

目的 比较不同年龄段男性急性ST段抬高型心肌梗死(ASTEMI)患者的临床特征,以期为临床制定有针对性的干预策略提供参考。方法 连续选取2016年1月—2018年6月于徐州医科大学附属医院行经皮冠状动脉介入治疗(PCI)的男性ASTEMI患者543例,根据发病年龄分为<55岁组163例、55~64岁组152例、65~74岁组138例、≥75岁组90例。比较4组患者一般资料、实验室检查指标、住院期间药物使用情况、发病诱因、住院期间主要不良心血管事件(MACE)发生情况、PCI相关情况。结果 (1)4组患者体质指数(BMI)、住院时间、冠心病重症监护室(CCU)入住时间、吸烟率、典型胸痛发生率、行急诊经皮冠状动脉介入治疗者所占比例、左心室射血分数(LVEF)比较,差异有统计学意义(P<0.05);4组患者收缩压、舒张压、饮酒率及高血压、糖尿病、高脂血症、脑梗死、陈旧性心肌梗死病史比较,差异无统计学意义(P>0.05)。(2)4组患者中性粒细胞与淋巴细胞比值(NLR)、血小板计数、三酰甘油(TG)、超敏C反应蛋白(hs-CRP)、N末端B型利钠肽前体(NT-proBNP)比较,差异有统计学意义(P<0.05);4组患者血红蛋白、总胆固醇(TC)、低密度脂蛋白(LDL)、高密度脂蛋白(HDL)、总胆红素、直接胆红素、肌酐、尿酸、空腹血糖、D-二聚体、纤维蛋白原、肌钙蛋白(TnI)峰值比较,差异无统计学意义(P>0.05)。(3)4组患者住院期间氯吡格雷、替格瑞洛使用率比较,差异有统计学意义(P<0.05);4组患者住院期间利尿剂、β-受体阻滞剂、血管紧张素转换酶抑制剂(ACEI)/血管紧张素Ⅱ受体阻滞剂(ARB)、他汀类药物使用率比较,差异无统计学意义(P>0.05)。(4)4组患者中因过量饮酒、感染而发病者所占比例比较,差异有统计学意义(P<0.05);4组患者中因体力应激、精神应激而发病者所占比例及无明显发病诱因者所占比例比较,差异无统计学意义(P>0.05)。(5)4组患者住院期间非致死性心肌梗死、再次血运重建、心源性休克、心力衰竭比较,差异无统计学意义(P>0.05),而4组患者住院期间恶性心律失常、全因死亡发生率比较,差异有统计学意义(P<0.05)。(6)4组患者心肌梗死部位,罪犯血管为左前降支(LAD)、左回旋支(LCX)、右冠状动脉(RCA)者所占比例,分叉病变为左主干(LM)-LAD-LCX、LAD-左回旋支对角支(DLCX)、LCX-钝缘支(OM)、RCA-左心室后支(PL)-后降支(PDA)者所占比例,慢血流及冠状动脉血栓负荷发生率比较,差异无统计学意义(P>0.05);4组患者冠状动脉病变支数、罪犯血管为左主干(LM)者所占比例、支架置入数、Gensini积分比较,差异有统计学意义(P<0.05)。结论 不同年龄段男性ASTEMI患者临床特征存在一定差异,<55岁男性ASTEMI主要与吸烟、过量饮酒、超重和/或肥胖等有关,且典型胸痛发生率较高,而≥75岁男性ASTEMI典型胸痛发生率较低、冠状动脉病变严重程度较重,因此应针对不同年龄段男性ASTEMI患者临床特征进行有针对性的干预。

Objective To compare the clinical features in male ASTEMI patients with different age groups,in order to provide a reference for making clinical targeted intervention strategy.Methods A total of 543 male ASTEMI patients underwent PCI were continuously selected in the Affiliated Hospital of Xuzhou Medical University from January 2016 to June 2018,and they were divided into A group(less than 55 years old,n=163),B group(55 to 64 years old,n=152),C group(65 to 74 years old,n=138)and D group(equal or over≥75 years old,n=90).General information,laboratory examination results,drug usage during hospitalization,predisposing factors,incidence of MACE during hospitalization and PCI related indicators were compared in the four groups.Results(1)There was statistically significant difference in BMI,hospital stays,CCU stays,smoking rate,incidence of typical chest pain,proportion of patients underwent emergency PCI and LVEF in the four groups,respectively(P<0.05),while there was no statistically significant difference in SBP,DBP,drinking rate,history of hypertension,diabetes,hyperlipidaemia,cerebral infarction or old myocardial infarction in the four groups(P>0.05).(2)There was statistically significant difference in NLR,PLT,TG,hs-CRP and NT-proBNP in the four groups,respectively(P<0.05),while there was no statistically significant difference in hemoglobin,TC,LDL,HDL,TBiL,DBiL,Cr,UA,FPG,D-dimer,FIB or peak value of TnI in the four groups(P>0.05).(3)There was statistically significant difference in utilization rate of clopidogrel and ticagrelor in the four groups,respectively(P<0.05),while there was no statistically significant difference in utilization rate of diuretic,β-acceptor blockers,ACEI/ARB or statins in the four groups(P>0.05).(4)There was statistically significant difference in proportion of patients attacked due to excessive drinking and infection in the four groups,respectively(P<0.05),while there was no statistically significant difference in proportion of patients attacked due to physical stress or mental stress,without obvious predisposing factors(P>0.05).(5)There was no statistically significant difference in incidence of nonfatal myocardial infarction,secondary revascularization,cardiogenic shock or heart failure in the four group during hospitalization(P>0.05),while there was statistically significant difference in incidence of malignant arrhythmia and all-cause death in the four groups,respectively(P<0.05).(6)There was no statistically significant difference in myocardial infarction location,proportion of patients with offending vessel of LAD,LCX or RCA,proportion of patients with bifurcation lesion of LM-LAD-LCX,LAD-DLCX,LCX-OM or RCA-PL-PDA,incidence of slow flow and coronary thrombus load in the four groups(P>0.05),while there was statistically significant difference in number of coronary artery lesions,proportion of patients with offending vessel of LM,number of implanted stents and Gensini score in the four groups,respectively(P<0.05).Conclusion There is significant difference in male ASTEMI patients with different age groups,smoking,excessive drinking,overweight and/or obesity are mainly correlated with ASTEMI in males less than 55 years old,and in which incidence of typical chest pain is relatively high,while incidence of typical chest pain is relatively lower in male ASTEMI patients equal or over 75 years old,and in which the severity of coronary artery lesion is more severe,thus we should conduct targeted interventions according to the clinical features in male ASTEMI patients with different age groups.