Juan-Salvadores Pablo, De La Torre Fonseca Luis Mariano, Calderon-Cruz Beatriz, Veiga Cesar, Pintos-Rodríguez Samuel, Fernandez Barbeira Saleta, Jimenez Diaz Victor Alfonso, Iñiguez Romo Andres
Cardiology, Hospital Alvaro Cunqueiro, Vigo, Spain
Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), Vigo, Spain.
Open Heart. 2025 Jan 28;12(1):e002957. doi: 10.1136/openhrt-2024-002957.
ST-elevation myocardial infarction (STEMI) is one of the most prevalent presentations in young patients. It is essential to emphasise that each minute of delay in providing medical care is negatively correlated to the patient's prognosis. The present study was carried out to evaluate the ischaemia-reperfusion times in patients ≤40 years of age versus individuals >40 years of age and their association with mortality and major adverse cardiac event (MACE) over the long term.
A retrospective, multicentre cohort study was carried out in 6799 patients diagnosed with STEMI. Two groups were established: patients diagnosed with STEMI and aged >40 years, and patients diagnosed with STEMI and aged ≤40 years.
The patients in the young group had a significantly sooner electrocardiographic diagnosis than the patients >40 years of age. A delay was observed in females, with a relative risk (RR) of 1.21 (95% CI 1.13 to 1.30) (p<0.001). Presenting dyspnoea (RR 1.76, 95% CI 1.5 to 2.06) (p<0.001) or going to a hospital without haemodynamics (RR 1.55, 95% CI 1.45 to 1.67) (p<0.001) was related to increased delay. The occurrence of MACE in the first year of follow-up was related to different risk factors, along with a delay in healthcare (HR 1.25, 95% CI 1.10 to 1.54) (p<0.042).
This study shows that young patients with STEMI tend to receive a sooner diagnosis than older individuals. Delays in healthcare represent one of the main factors related to the occurrence of MACE and non-event-free survival.
ST段抬高型心肌梗死（STEMI）是年轻患者中最常见的表现之一。必须强调的是，提供医疗护理的每一分钟延迟都与患者的预后呈负相关。本研究旨在评估年龄≤40岁的患者与年龄>40岁的患者的缺血再灌注时间，以及它们与长期死亡率和主要不良心脏事件（MACE）的关联。
对6799例诊断为STEMI的患者进行了一项回顾性多中心队列研究。设立了两组：诊断为STEMI且年龄>40岁的患者，以及诊断为STEMI且年龄≤40岁的患者。
年轻组患者的心电图诊断明显早于40岁以上的患者。女性存在延迟，相对风险（RR）为1.21（95%CI 1.13至1.30）（p<0.001）。出现呼吸困难（RR 1.76，95%CI 1.5至2.06）（p<0.001）或无血流动力学支持前往医院（RR 1.55，95%CI 1.45至1.67）（p<0.001）与延迟增加有关。随访第一年MACE的发生与不同风险因素有关，同时还与医疗护理延迟有关（HR 1.25，95%CI 1.10至1.54）（p<0.042）。
本研究表明，STEMI年轻患者的诊断往往比老年患者更早。医疗护理延迟是与MACE发生和无事件生存相关的主要因素之一。
