接受直接经皮冠状动脉介入治疗的青年急性ST段抬高心肌梗死患者的基线特征、治疗和30天预后Baseline characteristics, treatment and 30 day outcome of young patients undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction
王辉,刘震宇,张抒扬,沈珠军,范中杰,曾勇,谢洪智,王崇慧,金晓峰,方全,朱文玲
摘要(Abstract):
目的研究接受直接经皮冠状动脉介入治疗(primary percutaneous coronary intervention,PCI)的青年急性ST段抬高心肌梗死(ST-segment elevation myocardial infarction,STEMI)患者的基线特征、治疗和30 d预后。方法连续入选本院自2003年11月至2012年12月收治的接受直接PCI的STEMI患者,根据患者年龄分为青年组(年龄<45岁)和对照组(年龄≥45岁),比较两组患者临床和冠状动脉造影资料、药物和介入治疗情况以及30 d预后。结果共纳入957例患者,平均年龄(62.4±12.7)岁,男760例(79.4%)。其中,青年组111例(11.6%),平均年龄(40.8±4.0)岁,男100例(90.1%)。与对照组相比,青年组男性(90.1%比78.0%,P<0.001)、吸烟(78.4%比57.9%,P<0.001)、高脂血症(56.8%比45.6%,P=0.027)的比例更高;而高血压(36.0%比61.1%,P<0.001)、糖尿病(24.3%比36.4%,P=0.012)、卒中(1.8%比11.1%,P=0.002)、冠状动脉血运重建史(3.6%比9.7%,P=0.035)的比例更低。青年组冠状动脉单支病变的比例高于对照组(47.7%比17.8%,P<0.001),而三支病变的比例低于对照组(25.2%比49.6%,P<0.001)。青年组使用β阻滞剂(99.1%比89.6%,P=0.001)和血小板糖蛋白Ⅱb/Ⅲa抑制剂(44.1%比36.4%,P=0.044)高于对照组。青年组的症状-球囊扩张时间[270(180,420)min比300(180,480)min,P=0.048]和症状-入门时间[120(60,270)min比160(90,300)min,P=0.038]更短。青年组住院时间更短[(9.4±4.3)d比(12.3±7.4)d,P<0.001],左心室射血分数更高[(59.0±11.0)%比(57.0±12.0)%,P=0.034],30 d心力衰竭(6.3%比16.7%,P=0.005)和全因死亡(1.8%比6.7%,P=0.042)发生率更低。结论在接受直接PCI的STEMI患者中,青年患者与中老年患者相比,以男性为主,吸烟、高脂血症是其主要危险因素,合并症更少,冠状动脉多为单支病变,药物治疗更充分,再灌注治疗更及时,并发症更少,30 d预后更好。
关键词(KeyWords): 心肌梗死;经皮冠状动脉介入治疗;年龄组;预后
基金项目(Foundation):
作者(Author): 王辉,刘震宇,张抒扬,沈珠军,范中杰,曾勇,谢洪智,王崇慧,金晓峰,方全,朱文玲
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