Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts; Boston University School of Medicine, Boston, Massachusetts.
Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
J Am Coll Cardiol. 2020 Jun 9;75(22):2804-2815. doi: 10.1016/j.jacc.2020.03.074.
Left ventricular ejection fraction (EF) recovery is associated with better long-term outcomes after myocardial infarction (MI). However, the association between long-term outcomes and EF recovery among young MI patients has not been investigated.
This study sought to evaluate the prevalence of left ventricular systolic dysfunction among patients who experience their first MI at a young age and to compare outcomes between those who recovered their EF versus those who did not.
The YOUNG-MI registry is a retrospective cohort study of patients who experienced an MI at ≤50 years of age. EF at the time of MI and within 180 days post-MI were determined from all available medical records. The primary outcomes were all-cause and cardiovascular mortality.
There were 1,724 patients with baseline EF data: 503 (29%) had EF <50%, whereas 1,221 (71%) had a normal baseline EF. Patients with lower EF were more likely to have experienced ST-segment elevation MI, have higher troponin values, and have more severe angiographic coronary artery disease. Among patients with abnormal baseline EF, information on follow-up EF was available for 216, of whom 90 (42%) recovered their EF to ≥50%. Patients who experienced EF recovery had less severe angiographic disease, lower alcohol use, and a lower burden of comorbidities. Over a median follow-up of 11.1 years, EF recovery was associated with an ∼8-fold reduction in all-cause mortality (adjusted hazard ratio: 0.12; p = 0.001) and a ∼10-fold reduction in cardiovascular mortality (adjusted hazard ratio: 0.10; p = 0.025).
Nearly one-third of young patients presented with left ventricular dysfunction post-MI. Among them, EF recovery occurred in more than 40% and was independently associated with a substantial decrease in all-cause and cardiovascular mortality.
左心室射血分数（EF）恢复与心肌梗死后的长期预后相关更好。然而，年轻心肌梗死患者的长期预后与 EF 恢复之间的关系尚未得到研究。
本研究旨在评估年轻时发生首次心肌梗死后患者中左心室收缩功能障碍的发生率，并比较 EF 恢复组与未恢复组之间的结局。
YOUNG-MI 登记研究是一项回顾性队列研究，纳入了≤50 岁发生心肌梗死的患者。从所有可用的病历中确定心肌梗死后即刻和 180 天内的 EF。主要结局是全因和心血管死亡率。
共有 1724 例患者具有基线 EF 数据：503 例（29%）EF<50%，1221 例（71%）基线 EF 正常。EF 较低的患者更可能经历 ST 段抬高型心肌梗死，肌钙蛋白值更高，且存在更严重的冠状动脉造影狭窄。在基线 EF 异常的患者中，有 216 例患者可获得随访 EF 信息，其中 90 例（42%）EF 恢复至≥50%。EF 恢复的患者冠状动脉造影狭窄程度较轻，酒精使用较少，合并症负担较低。在中位随访 11.1 年期间，EF 恢复与全因死亡率降低约 8 倍相关（校正风险比：0.12；p=0.001），与心血管死亡率降低约 10 倍相关（校正风险比：0.10；p=0.025）。
近三分之一的年轻心肌梗死患者存在左心室功能障碍。其中，超过 40%的患者 EF 恢复，EF 恢复与全因和心血管死亡率的显著降低独立相关。
