Dimitrova Iva N
Cardiology, University Hospital "Prof. Alexandar Tschirkov", Medical University of Sofia, Sofia, BGR.
Cureus. 2023 Sep 22;15(9):e45803. doi: 10.7759/cureus.45803. eCollection 2023 Sep.
Cardiovascular diseases (CVDs) are the leading cause of global mortality and disability. Acute myocardial infarction (AMI) in young individuals is a rare condition but can cause devastating socioeconomic and psychological consequences for both the patient and their family and an economic burden for the government. There is a paucity of data concerning the specific profile of these young patients in Bulgaria, a country with a high burden of cardiovascular morbidity and mortality. Therefore, the aim of the present study was to assess the baseline characteristics, demographic and risk factor profile, clinical features, angiographic findings and in-hospital outcomes of young patients with AMI. Additionally, these data were compared to those of the older age group.
Retrospective data on 172 patients treated for AMI in "Prof. Alexandar Tschirkov", Bulgaria, from January 2018 to December 2021 were collected for the purpose of this study. Baseline characteristics, risk factor profile and clinical and angiographic features were compared in young (≤45 years) and older patients (>45 years).
Males were significantly predominant in the two age groups (p < 0.01), with an obviously increasing proportion of females in the older age group. Young patients were more likely to be smokers (55.7% vs. 28.8%; p=0.001); in contrast, hypertension (70.5% vs. 91.9%; p <0.001) and obesity (16.4% vs. 31.5%; p=0.031) were more prevalent in older patients. Anterior localization of myocardial infarction (MI) was most common in the two age groups (47.5% vs. 41.4%), respectively. Regarding the time delay from symptom onset to first medical contact, we found that young patients tended to present earlier than their older counterparts. Young patients had a higher incidence of single vessel disease (SVD) (49.2%) and nonobstructive coronary disease (NOCD) (11.5%) than older patients. Young patients with AMI had a lower in-hospital morbidity rate than older patients, but the in-hospital mortality, although lower, was not significantly different. A high prevalence of modifiable cardiovascular risk factors (RFs), such as smoking, dyslipidemia and arterial hypertension (AH), among the young group, less evolved CAD and similar high procedural success between age groups were established. Approximately 30% of young patients tend to present late in the hospital. The in-hospital mortality in the young population was lower than that in the older population but was still relatively higher than that previously reported.
The reported high prevalence of modifiable RFs and late presentation of young patients with AMI highlight the need for early recognition of these RFs, better prevention, deployment of educational programs, easy access to health care and high awareness of clinicians to reduce disability and mortality from CVD.
心血管疾病（CVDs）是全球死亡和残疾的主要原因。年轻个体的急性心肌梗死（AMI）是一种罕见疾病，但会给患者及其家庭带来毁灭性的社会经济和心理后果，并给政府带来经济负担。在心血管发病率和死亡率负担较高的保加利亚，关于这些年轻患者的具体情况的数据匮乏。因此，本研究的目的是评估年轻AMI患者的基线特征、人口统计学和风险因素概况、临床特征、血管造影结果及住院结局。此外，将这些数据与老年组的数据进行了比较。
为了本研究，收集了2018年1月至2021年12月在保加利亚“亚历山大·茨尔科夫教授”医院接受AMI治疗的172例患者的回顾性数据。比较了年轻（≤45岁）和老年患者（>45岁）的基线特征、风险因素概况以及临床和血管造影特征。
男性在两个年龄组中占显著优势（p<0.01），老年组中女性比例明显增加。年轻患者更可能是吸烟者（55.7%对28.8%；p=0.001）；相比之下，高血压（70.5%对91.9%；p<0.001）和肥胖（16.4%对31.5%；p=0.031）在老年患者中更为普遍。心肌梗死（MI）的前壁定位在两个年龄组中最为常见（分别为47.5%和41.4%）。关于从症状发作到首次就医的时间延迟，我们发现年轻患者比老年患者就诊更早。年轻患者单支血管病变（SVD）（49.2%）和非阻塞性冠状动脉疾病（NOCD）（11.5%）的发生率高于老年患者。年轻AMI患者的住院发病率低于老年患者，但住院死亡率虽低，但无显著差异。确定了年轻组中可改变的心血管危险因素（RFs），如吸烟、血脂异常和动脉高血压（AH）的高患病率，CAD进展较少以及不同年龄组之间手术成功率相似。约30%的年轻患者倾向于在医院就诊较晚。年轻人群的住院死亡率低于老年人群，但仍相对高于先前报道的水平。
所报道的年轻AMI患者中可改变的RFs高患病率和就诊较晚突出了早期识别这些RFs、更好的预防、开展教育项目、方便获得医疗保健以及提高临床医生意识以降低CVD导致的残疾和死亡率的必要性。
