Reinstadler Sebastian Johannes, Eitel Charlotte, Thieme Merle, Metzler Bernhard, Poess Janine, Desch Steffen, Thiele Holger, Eitel Ingo
Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Lübeck, Germany; University Clinic of Internal Medicine III, Department of Cardiology, and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
Department of Cardiology, Angiology, and Intensive Care Medicine, University Heart Center Lübeck, Medical Clinic II, University of Lübeck, Lübeck, Germany; German Centre for Cardiovascular Research (DZHK), Lübeck, Germany.
Am J Cardiol. 2016 May 1;117(9):1411-6. doi: 10.1016/j.amjcard.2016.02.005. Epub 2016 Feb 17.
It is unknown whether the occurrence of ST-elevation myocardial infarction (STEMI) at a younger age is associated with differences in myocardial damage compared with older patients. We aimed to compare the infarct characteristics (area at risk [AAR], myocardial salvage index [MSI], infarct size [IS], microvascular obstruction [MVO]) and clinical outcome in patients aged ≤45 years and >45 years. We analyzed 795 patients with STEMI treated with primary percutaneous coronary intervention. All patients completed 12-month follow-up for the assessment of major adverse cardiac events (MACE). Left ventricular ejection fraction, AAR, MSI, IS, and MVO were determined by cardiac magnetic resonance imaging. Seventy-eight patients (9.8%) were aged 45 years or younger. Young patients were more likely to be male (p = 0.01), to be current smokers (p <0.001), and to have a family history of coronary artery disease (p = 0.05). Contrary, they had significantly lower prevalence of hypertension (p <0.001), diabetes (p <0.01), and 3-vessel disease (p <0.01). There were no significant differences in left ventricular ejection fraction (p = 0.36), AAR (p = 0.30), MSI (p = 0.34), IS (p = 0.29), or MVO (p = 0.58) between both groups. MACE rate was significantly lower in patients aged ≤45 years compared with patients aged >45 years (1.3% vs 7.5%, p = 0.04). After multivariate adjustment for clinical risk factors and cardiac magnetic resonance findings, age remained an independent predictor of MACE (hazard ratio 1.04, 95% CI 1.01 to 1.07, p = 0.03). In conclusion, infarct characteristics are not dependent on age in patients undergoing primary percutaneous coronary intervention for STEMI.
与老年患者相比，年轻时发生ST段抬高型心肌梗死（STEMI）是否与心肌损伤差异相关尚不清楚。我们旨在比较年龄≤45岁和>45岁患者的梗死特征（危险区域面积[AAR]、心肌挽救指数[MSI]、梗死面积[IS]、微血管阻塞[MVO]）和临床结局。我们分析了795例接受直接经皮冠状动脉介入治疗的STEMI患者。所有患者均完成了为期12个月的随访，以评估主要不良心脏事件（MACE）。通过心脏磁共振成像测定左心室射血分数、AAR、MSI、IS和MVO。78例患者（9.8%）年龄在45岁及以下。年轻患者更可能为男性（p = 0.01）、当前吸烟者（p <0.001）且有冠状动脉疾病家族史（p = 0.05）。相反，他们的高血压（p <0.001）、糖尿病（p <0.01）和三支血管病变（p <0.01）患病率显著较低。两组之间的左心室射血分数（p = 0.36）、AAR（p = 0.30）、MSI（p = 0.34）、IS（p = 0.29）或MVO（p = 0.58）无显著差异。年龄≤45岁患者的MACE发生率显著低于年龄>45岁的患者（1.3%对7.5%，p = 0.04）。在对临床危险因素和心脏磁共振成像结果进行多变量调整后，年龄仍然是MACE的独立预测因素（风险比1.04，95%CI 1.01至1.07，p = 0.03）。总之，对于接受直接经皮冠状动脉介入治疗的STEMI患者，梗死特征不依赖于年龄。
