Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Italy.
Clinical Center of Serbia, Medical Faculty, University of Belgrade, Serbia.
J Am Heart Assoc. 2017 Dec 22;6(12):e007519. doi: 10.1161/JAHA.117.007519.
Although acute coronary syndrome (ACS) mainly occurs in patients >50 years, younger patients can be affected as well. We used an age cutoff of 45 years to investigate clinical characteristics and outcomes of "young" patients with ACS.
Between October 2010 and April 2016, 14 931 patients with ACS were enrolled in the ISACS-TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry. Of these patients, 1182 (8%) were aged ≤45 years (mean age, 40.3 years; 15.8% were women). The primary end point was 30-day all-cause mortality. Percentage diameter stenosis of ≤50% was defined as insignificant coronary disease. ST-segment-elevation myocardial infarction was the most common clinical manifestation of ACS in the young cases (68% versus 59.6%). Young patients had a higher incidence of insignificant coronary artery disease (11.4% versus 10.1%) and lesser extent of significant disease (single vessel, 62.7% versus 46.6%). The incidence of 30-day death was 1.3% versus 6.9% for the young and older patients, respectively. After correction for baseline and clinical differences, age ≤45 years was a predictor of survival in men (odds ratio, 0.24; 95% confidence interval, 0.10-0.58), but not in women (odds ratio, 1.35; 95% confidence interval, 0.50-3.62). This pattern of reversed risk among sexes held true after multivariable correction for in-hospital medications and reperfusion therapy. Moreover, younger women had worse outcomes than men of a similar age (odds ratio, 6.03; 95% confidence interval, 2.07-17.53).
ACS at a young age is characterized by less severe coronary disease and high prevalence of ST-segment-elevation myocardial infarction. Women have higher mortality than men. Young age is an independent predictor of lower 30-day mortality in men, but not in women.
URL: http://clinicaltrials.gov/. Unique identifier: NCT01218776.
尽管急性冠状动脉综合征（ACS）主要发生在>50 岁的患者中，但年轻患者也可能受到影响。我们使用 45 岁的年龄切点来研究“年轻”ACS 患者的临床特征和结局。
在 2010 年 10 月至 2016 年 4 月期间，ISACS-TC（转型国家急性冠状动脉综合征国际调查）登记处纳入了 14931 例 ACS 患者。其中 1182 例（8%）年龄≤45 岁（平均年龄 40.3 岁；15.8%为女性）。主要终点是 30 天全因死亡率。狭窄程度<50%定义为无意义的冠状动脉疾病。ST 段抬高型心肌梗死是年轻患者 ACS 最常见的临床表现（68%比 59.6%）。年轻患者无意义的冠状动脉疾病发生率较高（11.4%比 10.1%），而有意义疾病的程度较轻（单支血管病变，62.7%比 46.6%）。年轻患者和老年患者 30 天死亡率分别为 1.3%和 6.9%。在调整基线和临床差异后，年龄≤45 岁是男性生存的预测因素（比值比，0.24；95%置信区间，0.10-0.58），但不是女性（比值比，1.35；95%置信区间，0.50-3.62）。这种性别风险逆转的模式在住院药物和再灌注治疗的多变量校正后仍然成立。此外，年轻女性的结局比同龄男性更差（比值比，6.03；95%置信区间，2.07-17.53）。
年轻的 ACS 以较轻的冠状动脉疾病和 ST 段抬高型心肌梗死的高患病率为特征。女性死亡率高于男性。年轻是男性 30 天死亡率较低的独立预测因素，但不是女性。
