早发急性心肌梗死的影响因素及其PCI术后远期预后

Related factors and the long-term outcome after percutaneous coronary intervention of premature acute myocardial infarction

目的探索早发急性心肌梗死(AMI)的影响因素,并比较行经皮冠状动脉介入治疗(PCI)的早发与非早发AMI患者的长期预后。方法本研究为前瞻性队列研究。连续纳入2013年1至12月在阜外医院行PCI治疗的冠心病患者共10724例,其中符合AMI诊断标准者1920例,依据发病年龄将其分为早发AMI组(男性≤50岁,女性≤60岁)及非早发AMI组。收集两组患者的基线资料,采用多因素logistic回归模型分析早发AMI的影响因素。观察终点为:(1)主要不良心脑血管事件(MACCE),包括心原性死亡、心肌梗死、血运重建、卒中和支架内血栓;(2)出血事件。比较两组在住院期间及出院2、5年各临床事件的发生情况。结果共纳入1920例AMI患者,年龄(56.5±11.3)岁,男性1612例(84.0%)。早发AMI组701例,非早发AMI组1219例。两组在性别、体重指数、血脂、合并症、炎症指标等方面差异均有统计学意义(P均<0.05)。多因素logistic回归分析结果显示,体重指数(OR=1.06,95%CI 1.01~1.10,P<0.01)、甘油三酯(OR=1.47,95%CI 1.14~1.90,P<0.01)、血尿酸水平(OR=1.02,95%CI 1.01~1.04,P<0.01)、高密度脂蛋白胆固醇水平(OR=0.33,95%CI 0.14~0.78,P=0.01)、高血压病史(OR=0.72,95%CI 0.56~0.93,P=0.01)是早发AMI的独立影响因素。随访结果显示,与非早发AMI组患者比较,早发AMI组住院期间及出院后2、5年的全因死亡、心原性死亡发生率均较低;早发AMI组出院5年的MACCE及卒中发生率较低,而出血的发生率较高(P均<0.05)。结论代谢异常包括高体重指数、高甘油三酯、高血尿酸、低高密度脂蛋白胆固醇水平是早发AMI的独立影响因素。早发AMI患者PCI术后5年内缺血事件的发生率较低,但出血事件的发生率高于非早发AMI患者。

Objective To explore the related factors of premature acute myocardial infarction(AMI),and to compare the the long-term outcomes in patients with and without premature AMI after percutaneous coronary intervention(PCI).Methods This study was a prospective cohort study.From January 2013 to December 2013,10724 consecutive patients with coronary heart disease undergoing PCI in Fuwai Hospital were enrolled.Among them 1920 patients with the diagnosis of AMI were divided into two groups:premature AMI(man≤50 years old,woman≤60 years old)and non-premature AMI.The baseline characteristics were collected,and multivariate logistic regression was uesed to analysis the related factors of premature AMI.The clinical outcomes,including the major adverse cardiovascular and cerebrovascular events(MACCE)which was the composite of cardiac death,myocardial infarction,revascularization,stroke and stent thrombosis,as well as bleeding events,during hospitalization,at 2 years and 5 years follow-up were analyzed.Results A total of 1920 AMI patiens were included(age was(56.5±11.3)years old),with 1612(84.0%)males.There were statistically significant differences between the two groups in gender,body mass index,blood lipid,complications,inflammatory markers,etc(all P<0.05).Multivariate logistic regression analysis showed body mass index(OR=1.06,95%CI 1.01-1.10,P<0.01),triglyceride(OR=1.47,95%CI 1.14-1.90,P<0.01),serum uric acid level(OR=1.02,95%CI 1.01-1.04,P<0.01),high density lipoprotein cholesterol level(OR=0.33,95%CI 0.14-0.78,P=0.01)and history of hypertension(OR=0.72,95%CI 0.56-0.93,P=0.01)were independent related factors of premature AMI.The incidence of all-cause death and cardiac death were lower during hospitalization,at 2 years and 5 years follow-up in the premature AMI group than in non-premature AMI group(all P<0.05).In the premature AMI group,the incidence of MACCE and stroke was lower,with more bleeding events in 5 years follow-up(all P<0.05).Conclusions Metabolic abnormalities,including high BMI,high triglyceride level and high serum uric acid,low high-density lipoprotein cholesterol level are the related factor of premature AMI.The incidence of ischemic events in patients with premature AMI is lower,while the incidence of bleeding events is higher than non-premature AMI patients.