Center for Coronary Artery Disease, Division of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
Department of Radiology, Beijing Anzhen Hospital, Capital Medical University, 2 Anzhen Road, Chaoyang District, Beijing, 100029, China.
Eur Radiol. 2023 Jul;33(7):4637-4647. doi: 10.1007/s00330-023-09406-5. Epub 2023 Jan 26.
Young patients account for about half of ST-segment elevation myocardial infarction (STEMI) patients and display a unique risk profile compared with old patients. Whether these differences are related to disparities in ventricular remodeling remains unknown. This study aimed to evaluate age-related differences in ventricular remodeling after primary percutaneous coronary intervention (PPCI) for STEMI.
In this observational study, consecutive STEMI patients between October 2019 and March 2021 who underwent serial cardiovascular magnetic resonance at index admission (3 to 7 days) and 3 months after PPCI were enrolled. Adverse remodeling was defined as ≥ 10% enlargement in left ventricular end-diastolic volume index (LVEDVi), while reverse remodeling was defined as a decrease in left ventricular end-systolic volume index (LVESVi) of more than 10%.
A total of 123 patients were included and grouped into young (< 60 years, n = 71) and old (≥ 60 years, n = 52) patients. Despite generally similar baseline structural and infarct characteristics, LVESVi significantly decreased only in old patients during follow-up (p = 0.034). The incidence of adverse remodeling was higher (49.3% vs 30.8%, p = 0.039), while the incidence of reverse remodeling was lower (31.0% vs 53.8%, p = 0.011) in young compared with old patients. Younger age (< 60 years) was associated with a significantly higher risk of adverse remodeling (adjusted OR 3.51, 95% CI 1.41-8.74, p = 0.007) and lower incidence of reverse remodeling (adjusted OR 0.42, 95% CI 0.18-0.97, p = 0.046).
In STEMI patients undergoing PPCI, young patients are at a higher risk of adverse remodeling and less probably develop reverse remodeling than old patients. Equal or more attention should be paid to young patients with STEMI compared with their older counterparts.
• In STEMI patients undergoing PPCI, young patients displayed unfavorable remodeling compared with old patients. • Young patients are at a higher risk of adverse remodeling and less probably develop reverse remodeling than old patients. • Equal or more attention should be paid to young patients compared with their older counterparts.
年轻患者占 ST 段抬高型心肌梗死（STEMI）患者的一半左右，与老年患者相比具有独特的风险特征。这些差异是否与心室重构的差异有关尚不清楚。本研究旨在评估经皮冠状动脉介入治疗（PPCI）治疗 STEMI 后年龄相关的心室重构差异。
本观察性研究纳入了 2019 年 10 月至 2021 年 3 月期间接受连续心血管磁共振成像检查的 STEMI 患者，分别在入院时（3-7 天）和 PPCI 后 3 个月进行检查。不良重构定义为左心室舒张末期容积指数（LVEDVi）增加≥10%，而反向重构定义为左心室收缩末期容积指数（LVESVi）减少超过 10%。
共纳入 123 例患者，分为年轻（<60 岁，n=71）和老年（≥60 岁，n=52）患者。尽管基线结构和梗死特征大致相似，但仅在老年患者中，LVESVi 在随访期间显著降低（p=0.034）。与老年患者相比，年轻患者不良重构的发生率更高（49.3%比 30.8%，p=0.039），而反向重构的发生率更低（31.0%比 53.8%，p=0.011）。年龄较轻（<60 岁）与不良重构的风险显著增加相关（调整后的 OR 3.51，95%CI 1.41-8.74，p=0.007），反向重构的发生率降低相关（调整后的 OR 0.42，95%CI 0.18-0.97，p=0.046）。
在接受 PPCI 的 STEMI 患者中，年轻患者的不良重构风险较高，而反向重构的可能性较低。与老年患者相比，STEMI 的年轻患者应给予同等或更多关注。
• 在接受 PPCI 的 STEMI 患者中，年轻患者的心室重构较老年患者不利。• 与老年患者相比，年轻患者的不良重构风险更高，反向重构的可能性更低。• 与老年患者相比，应给予 STEMI 的年轻患者同等或更多关注。
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