Department of Cardiology, Hospital General Universitario Alicante, Alicante, Spain.
Int J Cardiol. 2010 Sep 3;143(3):249-54. doi: 10.1016/j.ijcard.2009.02.019. Epub 2009 Mar 17.
Intravascular thrombogenesis is influenced by a complex interplay of factors related to a procoagulant state, fibrinolysis, endothelial damage/dysfunction and inflammation. We hypothesised that abnormalities of these biological systems would contribute to outcome of coronary artery disease presenting at a young age.
We performed a prospective study of 142 subjects presenting with acute myocardial infarction (AMI) at a young age (defined as age ≤45 years), to determine the clinical and laboratory predictors of cardiovascular events during 36 months of follow-up. We assessed conventional risk factors and abnormalities of thrombophilia [total homocysteine (tHcy), lipoprotein (a) [Lp(a)], antiphospholipid antibodies (APA)], as well as lipid profile (total cholesterol, HDL-cholesterol, LDL-cholesterol and triglycerides), fibrinogen and fibrin D-dimer (as indices of a hypercoagulable state and thrombogenesis), von Willebrand factor (vWF, an index of endothelial damage/dysfunction), tissue plasminogen activator [t-PA antigen] and its inhibitor [PAI-1 antigen] (as indices of fibrinolysis), and C-reactive protein [CRP] (an index of inflammation).
In a multivariate analysis, the variables independently associated with cardiovascular events at follow-up were levels of homocysteine (OR 3.73, 95% CI (1.54-9.02); p=0.003), left ventricle systolic dysfunction (OR 3.04, 95% CI (1.00-9.25); p=0.050), and smoking habit (OR 2.79, 95% CI (1.09-7.14) p=0.032).
Prognostic markers associated with cardiovascular events in premature CAD (young AMI subjects) were cigarette smoking and EF<50% of left ventricle as conventional clinical risk factors, as well as higher levels of homocysteine.
血管内血栓形成受多种因素影响，这些因素与促凝状态、纤维蛋白溶解、内皮损伤/功能障碍和炎症有关。我们假设这些生物系统的异常会导致年轻患者发生冠状动脉疾病的结局恶化。
我们对 142 例年轻（定义为年龄≤45 岁）急性心肌梗死（AMI）患者进行了前瞻性研究，以确定 36 个月随访期间心血管事件的临床和实验室预测因子。我们评估了常规危险因素和血栓形成异常[总同型半胱氨酸（tHcy）、脂蛋白（a）[Lp（a）]、抗磷脂抗体（APA）]，以及血脂谱（总胆固醇、高密度脂蛋白胆固醇、低密度脂蛋白胆固醇和甘油三酯）、纤维蛋白原和纤维蛋白 D-二聚体（作为高凝状态和血栓形成的指标）、血管性血友病因子（vWF，内皮损伤/功能障碍的指标）、组织型纤溶酶原激活物[ t-PA 抗原]及其抑制剂[PAI-1 抗原]（作为纤维蛋白溶解的指标）和 C-反应蛋白 [CRP]（炎症的指标）。
在多变量分析中，与随访期间心血管事件独立相关的变量是同型半胱氨酸水平（OR 3.73，95%CI（1.54-9.02）；p=0.003）、左心室收缩功能障碍（OR 3.04，95%CI（1.00-9.25）；p=0.050）和吸烟习惯（OR 2.79，95%CI（1.09-7.14）；p=0.032）。
与年轻 CAD（年轻 AMI 患者）心血管事件相关的预后标志物是吸烟和左心室 EF<50%作为传统临床危险因素，以及同型半胱氨酸水平升高。
