不同年龄急性心肌梗死患者经皮冠状动脉介入治疗后的临床特点及预后

Clinical Characteristics and Prognosis of Patients with Acute Myocardial Infarction in Different Ages after PCI Treatment

目的:探讨不同年龄急性心肌梗死(AMI)患者经皮冠状动脉介入(PCI)治疗后的临床特点及预后。方法:选取行急诊PCI治疗的AMI患者450例,根据年龄将AMI患者分为30~44岁组、45~59岁组、60~74岁组及≥75岁组,收集4组患者的一般临床资料[年龄、性别及体质量指数(BMI)]、心血管危险因素(吸烟史、糖尿病史、高血压史、冠状动脉家族史及高胆固醇血症病史)、Killip分级、舒张压及收缩压、梗死相关动脉及临床用药情况[血管紧张素转化酶抑制剂(ACEI)/血管紧张素受体Ⅱ拮抗剂(ARB)、阿司匹林、β受体阻滞剂、他汀类药物、替罗非班、醛固酮受体拮抗剂及二磷酸腺苷(ADP)受体拮抗剂],记录PCI术前及术后TIMI分级、随访12个月发生的临床事件;采用Logistic多元回归分析AMI不同年龄与临床事件率的关系,采用K-M曲线分析各组患者的生存情况。结果:一般资料比较,30~44岁组AMI患者吸烟史、高胆固醇血症比例低于其他3组,差异有统计学意义(P<0.05);其余指标4组间比较,差异无统计学意义(P>0.05);4组AMI患者狭窄动脉数比较,30~44组1支血管病变发生率最高、≥75岁组3支血管病变发生率最高(P<0.05);4组AMI患者梗死相关动脉的发生率,使用阿司匹林、β受体阻断剂、ACEI/ARB、他汀类药物、醛固酮拮抗剂、替罗非班及ADP受体拮抗剂的比例比较,差异无统计学意义(P>0.05);30~44岁组、45~59岁组及60~74岁组患者心血管事件全因死亡率及总的发生率均低于≥75岁组,差异有统计学意义(P<0.05);K-M曲线结果显示30~44岁组、45~59岁组及60~74岁组AMI患者生存情况均优于≥75岁组,差异有统计学意义(P<0.05)。结论:年龄是影响AMI患者PCI治疗预后的重要危险因素,年轻AMI患者预后略优于年龄≥75岁的老年患者。

Objective:To investigate the clinical characteristics and prognosis of patients with acute myocardial infarction(AMI)in different ages after percutaneous coronary intervention(PCI).Methods:Four hundred and fifty patients who were hospitalized with acute myocardial infarction were treated with emergency PCI treatment after admission and these patients were divided into 4 groups according to their ages(30-44 year-old group,45-59 year-old group,60-74 year-old group and 75 years old and above group).Information of these four groups were collected,including general clinical data(age,gender and body BMI),cardiovascular risk factors(history of smoking,diabetes,hypertension,coronary artery family history and hypercholesterolemia),Killip classification,diastolic and systolic blood pressure,infarct-related arteries and clinical medications[Angiotensin Converting Enzyme Inhibitor(ACEI)/Angiotensin Receptor II Antagonist(ARB),Aspirin,Beta Blocker,Statins,Tirofiban,aldosterone receptor antagonist and adenosine diphosphate(ADP)receptor antagonist].TIMI grading before and after PCI,and the clinical events that occurred after 12 months of follow-up were recorded.Logistic multiple regression analysis was used to analyze the relationship between different ages of AMI and clinical event rates,and the K-M curve was used to analyze the survival of patients in each group.Results:In baseline characteristics,the proportion of smoking history and hypercholesterolemia in 30-44 year-old AMI patients was lower than that of the other three groups,the difference was statistically significant(P<0.05);the other indicators among the 4 groups were not statistically significant(P>0.05);Comparing the number of stenotic arteries in AMI patients in 4 age groups,the incidence of 1 vessel disease in the 30-44 year-old group was the highest,and the incidence of 3 vessels in the 75 years old and above group was the highest(P<0.05);There was no significant difference in the incidence of infarct related artery and the proportion of aspirin,β-blockers,ACEI/ARB,statins,aldosterone antagonists,tirofiban and ADP receptor antagonists among the four age groups(P>0.05);The all-cause mortality and total incidence of cardiovascular events in patients aged 30-44,45-59,and 60-74 were lower than those in the 75 years old and above group,and the difference was statistically significant(P<0.05);K-M curve results showed that the survival of AMI patients in the ages of 30-44,45-59 and 60-74 were better than those of the 75 years old and above group,and the difference was statistically significant(P<0.05).Conclusion:Age is an important risk factor affecting the prognosis of AMI patients with PCI.The prognosis of young AMI patients is slightly better than that of elderly patients≥75 years old.