青年ST段抬高型心肌梗死冠状动脉3支病变患者临床特点及影响因素分析

Clinical characteristics and risk factors fortriple-vessel coronary artery disease in young patients with ST-segment elevation myocardial infarction

目的:评估青年ST段抬高型心肌梗死(STEMI)冠状动脉3支病变患者临床特点和影响因素。方法:连续入选2011年1月至2021年10月,在北京同仁医院就诊的≤45岁并行冠状动脉造影首次诊断阻塞性冠状动脉疾病导致的STEMI患者312例。根据冠状动脉造影结果,分为冠状动脉3支病变(TVD)组和非3支病变(NTVD)组。比较两组临床资料,采用二分类Logistic回归模型分析冠状动脉3支病变影响因素。结果:与NTVD组相比,TVD组患者年龄更大,吸烟比例更高,有糖尿病、高脂血症、高血压病史更多、空腹血糖、HbA1c、LDL-C水平更高(P<0.05)。结论:青年STEMI冠状动脉3支病变患者比例较高,年龄、吸烟、糖尿病、高脂血症、高血压病史和入院时LDL-C水平是青年STEMI患者冠状动脉3支病变的危险因素,除年龄外均为可防可控的危险因素,提示STEMI冠状动脉3支病变已成为一种生活方式病。

Objective: To evaluate the clinical characteristics and risk factors for triple-vessel coronary artery disease(TVD) in young patients with ST-segment elevation myocardial infarction(STEMI).Methods: A retrospective study was performed on 312 patients aged ≤ 45 years who undenvent coronary angiography and diagnosed with STEMI for the first time in Beijing Tongren Hospital from January 2011 to October 2021. Clinical and demographic data were collected from the hospital records by trained abstractors.All patients were divided into the TVD group(n=229) and NTVD group(n=83) according to the results of coronary angiography. Clinical characteristics, reperfusion therapy and inhospital outcomes were compared,and the risk factors for TVD were analyzed by binary Logistic regression model. Results: In total of patients,mean age was(39.2±4.7) years, men accounted for 97.8%, smokers accounted for 84%. Compared with the none-TVD group, the patients in the TVD group were older, had a higher proportion of smoking, and more patients had a history of diabetes, hyperlipidemia, and hypertension(P<0.05). Fasting blood glucose,glycosylated hemoglobin, as well as LDL-C levels were higher in TVD group(P<0.05). Conclusions:The proportion of TVD in young patients with STEMI is relatively high. Age, history of smoking, diabetes,hyperlipidemia, hypertension and LDL-C level at the admission are independent risk factors for the triplevessel coronary artery disease in young patients with STEMI, all risk factors are preventable except for age,which indicates STEMI-TVD has become a lifestyle disease.