Liu Jian-Di, Gong Ren, Xu Jin-Song, Zhang Shi-Yuan, Wu Yan-Qing
Department of Cardiology, The Second Affiliated Hospital of Nanchang University.
Int Heart J. 2023 Mar 31;64(2):128-136. doi: 10.1536/ihj.22-435. Epub 2023 Mar 15.
This study aimed to investigate the clinical characteristics and major adverse cardiovascular events (MACEs) of Chinese patients with premature acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI). This study was a secondary retrospective analysis involving 2114 ACS patients undergoing PCI at a single center in China. The patients were divided into two groups according to age (premature ACS group: ≤ 55 years in men, ≤ 65 years in women; nonpremature ACS group: > 55 years in men, > 65 years in women). The primary endpoint was all-cause death, and the secondary endpoint was a composite of all-cause death, nonfatal myocardial infarction, nonfatal stroke, target vessel revascularization, and recurrent angina at follow-up, defined as MACEs. The incidence of all-cause death and MACEs was significantly lower in the premature than in the nonpremature ACS group (P < 0.001). Female sex, higher triglyceride levels, and higher low-density lipoprotein cholesterol levels were identified as independent risk factors that accelerated the development of ACS, whereas higher high-density lipoprotein cholesterol levels were identified as protective factors. Furthermore, in patients with premature ACS, non-ST-elevation ACS, cardiac insufficiency, multivessel disease, and left main lesion were risk factors for MACEs. Younger individuals, especially females, are advised to undergo early screening for the risk factors of premature ACS. Primary prevention of dyslipidemia should be more aggressively promoted at a young age. For premature ACS patients undergoing PCI, strengthened management and regular re-examinations are necessary to avoid adverse cardiovascular events as much as possible.
本研究旨在调查接受经皮冠状动脉介入治疗（PCI）的中国早发急性冠状动脉综合征（ACS）患者的临床特征及主要不良心血管事件（MACE）。本研究为一项二次回顾性分析，纳入了在中国某单中心接受PCI的2114例ACS患者。根据年龄将患者分为两组（早发ACS组：男性≤55岁，女性≤65岁；非早发ACS组：男性>55岁，女性>65岁）。主要终点为全因死亡，次要终点为随访时全因死亡、非致死性心肌梗死、非致死性卒中、靶血管血运重建及复发性心绞痛的复合终点，定义为MACE。早发ACS组的全因死亡和MACE发生率显著低于非早发ACS组（P<0.001）。女性、较高的甘油三酯水平和较高的低密度脂蛋白胆固醇水平被确定为加速ACS发展的独立危险因素，而较高的高密度脂蛋白胆固醇水平被确定为保护因素。此外，在早发ACS患者中，非ST段抬高型ACS、心功能不全、多支血管病变和左主干病变是MACE的危险因素。建议年轻个体，尤其是女性，对早发ACS的危险因素进行早期筛查。应在年轻时更积极地推动血脂异常的一级预防。对于接受PCI的早发ACS患者，加强管理和定期复查对于尽可能避免不良心血管事件是必要的。
