Bruno Francesco, Moirano Giovenale, Budano Carlo, Lalloni Stefania, Ciccone Giovannino, Verardi Roberto, Andreis Alessandro, Montabone Andrea, De Filippo Ovidio, Gallone Guglielmo, Gilardetti Marco, D'Ascenzo Fabrizio, De Ferrari Gaetano Maria
Division of Cardiology, Cardiovascular and Thoracic Department, Città della Salute e della Scienza Hospital and University of Turin, Italy.
Epidemiology Unit, Department of Medical Sciences, University of Turin, Italy.
Int J Cardiol. 2022 Jun 15;357:134-139. doi: 10.1016/j.ijcard.2022.03.012. Epub 2022 Mar 15.
Data about long-term clinical outcomes of young patients experiencing an acute myocardial infarction (MI) and about the potential impact of gender on juvenile MI incidence and prognosis are scant.
Hospital Discharge Register records of Piedmont region (Italy) from 2007 to 2018 were interrogated to identify incident juvenile MI cases and MI recurrences. Patients were considered young if the first MI occurred before or at 47 years of age (5th percentile). Incidence of first juvenile MI event and overall survival were the primary outcomes. Gender differences and survival rate after an MI recurrence were secondary outcomes. Out of 114.816 hospitalizations due to MI, 4482 (3.9%) occurred in people aged ≤47. Average incidence rate of juvenile MI over the study period was 24.5 (23.8-25.2) per 100.000 person-years, with a decline among men and a stable trend among women through the years. The risk of in hospital death was higher for women (1.9% vs. 0.9%, p = 0.02), while the survival rate at 10 years after the first MI was 94.8%, without gender differences (HR 1.05: 0.69-1.60). MI recurrence occurred in 348 (7.8%) and was less common in women (HR 0.72: 0.52-0.99). After multivariate adjustment, MI recurrence was associated with a significantly higher risk of death at follow-up as compared with a single MI episode (HR 3.05: 1.9-4.80, all CI 95%).
Among young patients with MI, women had a higher in-hospital mortality compared to men, but long-term prognosis after hospital discharge did not differ. MI recurrences were associated with increased mortality at follow up.
关于急性心肌梗死（MI）年轻患者的长期临床结局以及性别对青少年MI发病率和预后的潜在影响的数据很少。
查询了意大利皮埃蒙特地区2007年至2018年的医院出院登记记录，以确定青少年MI病例和MI复发情况。如果首次MI发生在47岁之前或47岁时（第5百分位数），则患者被视为年轻人。首次青少年MI事件的发生率和总生存率是主要结局。MI复发后的性别差异和生存率是次要结局。在因MI住院的114816例患者中，4482例（3.9%）发生在47岁及以下人群中。研究期间青少年MI的平均发病率为每100000人年24.5（23.8 - 25.2）例，多年来男性发病率呈下降趋势，女性呈稳定趋势。女性住院死亡风险更高（1.9%对0.9%，p = 0.02），而首次MI后10年的生存率为94.8%，无性别差异（风险比1.05：0.69 - 1.60）。348例（7.8%）发生了MI复发，女性中较少见（风险比0.72：0.52 - 0.99）。多变量调整后，与单次MI发作相比，MI复发与随访时死亡风险显著升高相关（风险比3.05：1.9 - 4.80，所有置信区间95%）。
在年轻的MI患者中，女性住院死亡率高于男性，但出院后的长期预后无差异。MI复发与随访时死亡率增加相关。
