Department of Cardiology, U.N. Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, Gujarat, India.
Department of Cardiology, Kasturba Medical College, Manipal University, Manipal, Karnataka, India.
Glob Heart. 2019 Mar;14(1):27-33. doi: 10.1016/j.gheart.2018.12.001. Epub 2019 Feb 4.
Myocardial infarction is among the leading causes of morbidity and mortality in young adults around the world.
In the YOUTH (Young Myocardial Infarction Study of the Western Indians) registry, we aimed to evaluate risk factor profile and angiographic outcomes of reperfusion therapies of infarct-related artery in young western Indians (≤40 years) having ST-segment elevation myocardial infarction.
A total of 1,179 consecutive patients aged ≤40 years who presented with ischemic heart disease from June 2012 to December 2014 were enrolled in the YOUTH registry. A total of 787 patients with ST-segment elevation myocardial infarction were further evaluated. Categorical data was assessed using chi-square test, whereas continuous data was assessed using Student's t test. Regression analysis was performed to investigate the strength of association.
In the YOUTH registry, the study population was predominantly male (93%) with tobacco consumption as major prevalent risk factor (49.7%). Of 787 patients, 451 (57.31%) were thrombolyzed, 326 (41.42%) did not receive any reperfusion therapy, and 10 patients (1.27%) underwent primary angioplasty. Younger age, window period <6 h, and lower lipoprotein (a) level were observed in patients with a recanalized infarct-related artery. Regression analysis showed window period of thrombolysis as strongest predictor (odds ratio: 1.790, 95% confidence interval: 1.144-2.802; p < 0.011) of successful reperfusion. Patients (n = 235) being thrombolyzed in a window period of <6 h, had higher rate of infarct-related artery recanalization (77%) as compared to those with ≥6 h window period (23%). In-hospital mortality was 0.38% (n = 3), whereas bleeding complication was noted only in 1 patient.
We herewith conclude that acute short-term outcome is favorable in young ST-segment elevation myocardial infarction patients, particularly in those who had received timely thrombolytic therapy. Though tobacco consumption was a major contributor of risk in young adults, prevalence of other risk factors was low in young Western Indians.
心肌梗死是全世界导致年轻人发病率和死亡率的主要原因之一。
在 YOUTH（西方印第安年轻人心肌梗死研究）登记处，我们旨在评估年轻的西部印第安人（≤40 岁）发生 ST 段抬高型心肌梗死时梗死相关动脉再灌注治疗的危险因素谱和血管造影结果。
共有 1179 名年龄≤40 岁的连续患者因缺血性心脏病于 2012 年 6 月至 2014 年 12 月入组 YOUTH 登记处。进一步评估了 787 例 ST 段抬高型心肌梗死患者。采用卡方检验评估分类数据，采用 Student's t 检验评估连续数据。进行回归分析以调查关联强度。
在 YOUTH 登记处，研究人群主要为男性（93%），主要流行的危险因素是烟草消费（49.7%）。在 787 例患者中，451 例（57.31%）接受溶栓治疗，326 例（41.42%）未接受任何再灌注治疗，10 例（1.27%）接受直接经皮冠状动脉介入治疗。在再通的梗死相关动脉患者中，年龄较小、溶栓时间窗<6 小时和脂蛋白（a）水平较低。回归分析显示溶栓时间窗是再灌注成功的最强预测因素（比值比：1.790，95%置信区间：1.144-2.802；p<0.011）。在时间窗<6 小时内溶栓的患者（n=235），梗死相关动脉再通率（77%）高于时间窗≥6 小时的患者（23%）。住院期间死亡率为 0.38%（n=3），仅 1 例患者出现出血并发症。
我们得出结论，急性短期预后在年轻的 ST 段抬高型心肌梗死患者中是有利的，特别是那些接受及时溶栓治疗的患者。尽管吸烟是年轻人的主要危险因素，但年轻的西部印第安人中其他危险因素的患病率较低。
