Chen Shyh-Ming, Tsai Tzu-Hsien, Hang Chi-Ling, Yip Hon-Kan, Fang Chi-Yuan, Wu Chiung-Jen, Guo Gary Bih-Fang
Division of Cardiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center, Chang Gung University College of Medicine, 123 Tapei Road, Niao Sung Hsiang, Kaohsiung Hsien, Taiwan, ROC.
Heart Vessels. 2011 Jan;26(1):2-9. doi: 10.1007/s00380-010-0017-0. Epub 2010 Oct 15.
Endothelial dysfunction may be particularly important in the pathogenesis of young patients with acute myocardial infarction (AMI), because they have different clinical characteristics compared with older patients. We investigated endothelial function in relation to AMI in this young age group. From January 2005 to March 2008, 29 of 31 consecutive patients with acute ST-elevation myocardial infarction (STEMI) who were <40 years old and received direct percutaneous coronary intervention (PCI) were enrolled in the study. We compared the coronary risk factors and flow-mediated vasodilation (FMD) in the brachial artery between the acute STEMI patients and 29 age- and gender-matched controls that did not have AMI. Baseline brachial artery diameter and responses to glyceryl trinitrate were similar between the two groups. In contrast, FMD was significantly lower in the young acute STEMI group than in the control (3.47 ± 4.08 vs. 7.45 ± 4.67%, p = 0.001) and correlated with the Thrombolysis in Myocardial Infarction (TIMI) risk score. The impaired FMD in the acute STEMI group was independent of smoking, hyperlipidemia, hypertension, nitrate use, or body mass index. In multiple logistic regression analysis, only FMD and age, not traditional cardiovascular risk factors, were found to be significantly associated with acute STEMI (odds ratio = 0.75, 95% CI 0.63-0.90, p < 0.01). In conclusion, independent of conventional risk factors, severe endothelial dysfunction occurs in young acute STEMI patients and correlates with TIMI score. In addition to age, impaired FMD is the only significant factor associated with acute STEMI in this young population.
内皮功能障碍在年轻急性心肌梗死（AMI）患者的发病机制中可能尤为重要，因为与老年患者相比，他们具有不同的临床特征。我们在这个年轻人群中研究了与AMI相关的内皮功能。从2005年1月至2008年3月，连续31例年龄小于40岁且接受直接经皮冠状动脉介入治疗（PCI）的急性ST段抬高型心肌梗死（STEMI）患者中的29例被纳入研究。我们比较了急性STEMI患者与29例年龄和性别匹配的非AMI对照者的冠状动脉危险因素和肱动脉血流介导的血管舒张（FMD）。两组之间的基线肱动脉直径和对硝酸甘油的反应相似。相比之下，年轻急性STEMI组的FMD明显低于对照组（3.47±4.08 vs. 7.45±4.67%，p = 0.001），并且与心肌梗死溶栓（TIMI）风险评分相关。急性STEMI组中FMD受损与吸烟、高脂血症、高血压、硝酸酯类药物使用或体重指数无关。在多因素逻辑回归分析中，发现只有FMD和年龄，而非传统心血管危险因素，与急性STEMI显著相关（优势比=0.75，95%CI 0.63 - 0.90，p < 0.01）。总之，独立于传统危险因素，年轻急性STEMI患者存在严重的内皮功能障碍，且与TIMI评分相关。在这个年轻人群中，除年龄外，FMD受损是与急性STEMI相关的唯一重要因素。
