Department of Cardiology, The First Hospital of Jilin University, Changchun, China.
Department of Cardiology, The First Hospital of Jilin University, Changchun, China.
Am J Med Sci. 2018 Jun;355(6):544-552. doi: 10.1016/j.amjms.2018.02.003. Epub 2018 Feb 8.
There are few published studies of ST-segment elevation myocardial infarction (STEMI) in younger individuals. The differences between these "younger" and "older" individuals may not be fully appreciated by clinicians. The aim of this study was to determine the reasons for the earlier presentation and help to identify strategies for prevention of recurrent myocardial infarction (MI) in younger patients.
The study population was a cohort of 2,419 consecutive STEMI patients who were treated with primary percutaneous coronary intervention. The median follow-up time of this retrospective study was 2.2 years.
The all-cause mortality rates in patients ≤45 years of age at 30 days, 1 and 2 years were 1.7%, 2.0% and 2.2%, respectively. These rates were lower compared with their older matched counterparts whose all-cause mortality rates were 3.3%, 4.2% and 5.5%, respectively (P = 0.010). The incidence of recurrent MI was 4.0% for all age groups combined, 5.4% for younger patients and 3.8% for older patients. The number of stents showed association with recurrent MI in older patients with a first infarction, whereas only composition factor 1 with significantly higher non-high-density lipoprotein and low-density lipoprotein values was significantly associated with recurrent MI in the younger patients.
STEMI patients ≤45 years of age more often had lower rates of all-cause mortality, but the risk of recurrent MI was similar to that of older patients. Regardless of triglyceride level, neither non-high-density lipoprotein nor low-density lipoprotein were independent predictors for recurrent MI during the long-term follow-up in younger patients.
鲜有研究报道年轻个体的 ST 段抬高型心肌梗死(STEMI)。临床医生可能并未充分了解这些“年轻”和“年老”个体之间的差异。本研究旨在确定年轻个体更早出现症状的原因,并帮助确定预防年轻患者再次发生心肌梗死(MI)的策略。
研究人群为 2419 例连续接受直接经皮冠状动脉介入治疗的 STEMI 患者。本回顾性研究的中位随访时间为 2.2 年。
年龄≤45 岁的患者在 30 天、1 年和 2 年的全因死亡率分别为 1.7%、2.0%和 2.2%,低于年龄匹配的老年患者的全因死亡率(分别为 3.3%、4.2%和 5.5%,P = 0.010)。所有年龄组的复发性 MI 发生率为 4.0%,年轻患者为 5.4%,老年患者为 3.8%。首次梗死的老年患者中支架数量与复发性 MI 相关,而仅年轻患者的组成因子 1 与非高密度脂蛋白和低密度脂蛋白值显著升高显著相关。
年龄≤45 岁的 STEMI 患者的全因死亡率较低,但再次发生 MI 的风险与老年患者相似。无论甘油三酯水平如何,非高密度脂蛋白和低密度脂蛋白均不是年轻患者长期随访中复发性 MI 的独立预测因素。