Magnusson Bjorn Jakob, Agnarsson Uggi, Guðnason Thorarinn, Þorgeirsson Gudmundur
Laeknabladid. 2017;103(1):11-15. doi: 10.17992/lbl.2017.01.115.
While acute myocardial infarction (AMI) mostly is a disease of the elderly it also affects younger individuals, often with serious consequenses. In 1980-1984 a study was carried out on the incidence, risk factors, infarct location and distribution of atherosclerosis among Icelanders forty years and younger with AMI. Here we present the results of a similar study carried out for the five year period 2005-2009.
Medical and autopsy records of all individuals, forty years and younger, diagnosed with AMI (I21 in ICD-10) at Landspitali, National University Hospital 2005-2009, or suffering sudden cardiac death in Iceland during the same period were reviewed. Blood tests, electrocardiograms, echocardiograms, coronary angiograms and autopsy results were reviewed with respect to AMI-criteria. Statistical comparisons of ratios and means were carried out using Chi-square test and T-test, respectively.
38 individuals 40 years and younger, 32 males and 6 females, fulfilled the diagnostic criteria of AMI. Calculated incidence for the population at risk was 10/100.000/year (14/100.000/year in 1980-1984) and the mean age ±S.D. was 36.7±3.9. Three (7.9%) died suddenly before reaching hospital but of the 35 hospitalised patients 30 day mortality was zero, compared to nine (23.7%) pre-hospital deaths and two (6.9%) hospital deaths in 1980-1984. Thus, combined pre-hospital and in-hospital (30 day) mortality was 28.9% and 7.9% in the previous and recent time periods, respectively (p=0.02). In 2005-2009, 77.1% had a smoking history and 31.4% were hypertensive compared to 97% and 6.9% in 1980-85 (p=0.026 and p=0.015, respectively). Body mass index (BMI) was higher in the later period, 28.6±4,8 kg/m2 compared to 26.1±3.6 (mean±S.D.; p=0.04) but s-cholesterol was lower, 5.1±1.4 mmol/L compared to 6.3±1.16 ( mean±S.D.; p<0.01). In both studies single coronary artery disease was the most common angiographic pattern and the left anterior descending artery most often involved.
Our results show that in two surveys 25 years apart AMI patients 40 years and younger are most often men. Smoking and family history were the most prominent risk factors during both periods but hypertension and high BMI were more common in 2005-2009 than in 1980-1984. Prognosis, as indicated by combined pre-hospital and in-hospital (30 day) mortality has improved. Key words: Myocardial infarction, forty and younger, incidence, risk factors, mortality, time trend Correspondence: Gudmundur Thorgeirsson gudmth@landspitali.is.
虽然急性心肌梗死（AMI）大多是一种老年疾病，但它也会影响年轻人，且常常带来严重后果。1980年至1984年期间，针对40岁及以下患有AMI的冰岛人，开展了一项关于AMI发病率、风险因素、梗死部位及动脉粥样硬化分布情况的研究。在此，我们展示了2005年至2009年这五年间一项类似研究的结果。
回顾了2005年至2009年期间在国立大学医院Landspitali被诊断为AMI（国际疾病分类第10版中的I21）的所有40岁及以下个体的医疗及尸检记录，以及同期在冰岛发生心源性猝死的个体记录。根据AMI标准对血液检测、心电图、超声心动图、冠状动脉造影及尸检结果进行了回顾。分别使用卡方检验和T检验对比例和均值进行统计学比较。
38名40岁及以下个体符合AMI诊断标准，其中男性32名，女性6名。计算得出的危险人群发病率为每年10/100,000（1980年至1984年为每年14/100,000），平均年龄±标准差为36.7±3.9岁。3人（7.9%）在入院前突然死亡，但在35名住院患者中，30天死亡率为零，而在1980年至1984年，有9人（23.7%）院前死亡，2人（6.9%）院内死亡。因此，在前一时期和最近时期，院前及院内（30天）综合死亡率分别为28.9%和7.9%（p = 0.02）。2005年至2009年期间，77.1%有吸烟史，31.4%患有高血压，而在1980年至1985年分别为97%和6.9%（分别为p = 0.026和p = 0.015）。后期体重指数（BMI）更高，为28.6±4.8kg/m²，而之前为26.1±3.6（均值±标准差；p = 0.04），但血清胆固醇更低，为5.1±1.4mmol/L，而之前为6.3±1.16（均值±标准差；p < 0.01）。在两项研究中，单支冠状动脉疾病都是最常见的血管造影模式，且左前降支动脉最常受累。
我们的结果表明，在相隔25年的两项调查中，40岁及以下的AMI患者大多为男性。吸烟和家族史在两个时期都是最突出的风险因素，但2005年至2009年期间高血压和高BMI比1980年至1984年更为常见。院前及院内（30天）综合死亡率所显示的预后情况有所改善。关键词：心肌梗死，40岁及以下，发病率，风险因素，死亡率，时间趋势通信作者：古德蒙德·索尔吉尔松gudmth@landspitali.is
