| Objectives: To investigate the clinical features of young patients withacute myocardial infarction (AMI) and to analyze the therapeutic effects ofemergency percutaneous coronary intervention (pPCI).Methods: From January2010to September2011, a total of98consecutive patients with first-time ST-elevation myocardial infarction(STEMI) who underwent primary PCI within12hours of symptom onset wereenrolled in this study, and were divided into young patients group (age≤45years old) and old patients group (age≥65years old). Inclusion criteria:(1)typical clinical presentation, ST elevation of over0.2mm in two or moreadjacent precordial leads or0.1mm in adjacent limb leads, and a rise ofcreatine kinase twice over the upper limit of normal status or an elevation oftroponin I;(2) within12hours from symptom onset;(3) TIMI flow ofinfarction related artery (IRA)≤2with serious stenosis (LM≥50%,OtherIRA≥75%) determined by the quantitative coronary analysis(QCA). Exclusioncriteria:(1) Allergic to Contrast agent, aspirin and anticoagulants;(2)activeinternal bleeding;(3)histories of hemorrhagic cerebrovascular events orischemic cerebrovascular events (including transient ischemic) within sixmonths;(4)coagulopathy and thrombocytopenia;(5)a high degree of suspicionof aortic dissection or aneurysm;(6)serious hepatic and renal insufficiency;(7)cardiogenic shock or previous myocardial infarction, history of PCI andcoronary artery bypass grafting;(8)pregnancy or lactation;(9)incidence ofmore than12hours;(10)severe heart failure;(11) the informed consent wasnot signed;(12)severe valvular heart disease;(13)malignancies, autoimmunediseases. Emergency coronary angiography was performed to clarify thelesions of IRA after adequate preparation, and pPCI was performed in patients with serious stenosis. The drug eluting stents were used in all lesions. Theclinical data, the characteristics of coronary lesions, immediate success rate ofpPCI, major adverse cardiac events (MACE), cardiac function and coronaryangiography results were compared after6-month follow-up. All data wereapplicated by SPSS13.0software package for statistical analysis, and a P<0.05was considered significant difference.Results:A total of98STEMI patients were enrolled, with42cases in the youngpatients group and56cases in the old patients group.1The proportions of male, smoking, family history, obesity were higher inyoung patients group (all P<0.05). The proportions of diabetes andhypertention were lower in young patients group (both P<0.05). There was nodifference in dyslipidemia between two groups (P>0.05).2Compared with the old patients group, more predisposing factors were foundin the young patient group (alcohol, fatigue, nervousness, agitation, etc.)(allP=0.005).3There was more single-vessel disease in the young patients group, with lesscalcification and collateral circulation (all P<0.05). There was a trend of lessthrombus burden in youth patients group (P>0.05).4The success rate immediately after PCI was higher in the youth patientsgroup than that in the old patient group (P=0.048). The incidence of no-reflowwas less in the young patient group, but the difference was not statisticallysignificant (P>0.05). The bleeding complications during hospitalization in theyoung patients group was significantly less than that in the old patients group(P<0.05).5The incidences of MACE after6-month follow-up in young patients groupwere significantly lower than those in the elderly group (P=0.001). The heartfunction was improved in both groups, and the systolic function was better inthe young patients group (P<0.05). There was no significant difference inTIMI flow of IRA between the two groups after6-month follow-up (P>0.05).The incidence of in-stent thrombosis in the young patients group was slightly lower than that the elderly group (P>0.05).Conclusions:1Compared with elderly patients with AMI, the risk factors in the young AMIpatients are more common including male gender, current smoking, familyhistory of cardiovascular disease, obesity, alcohol abuse, fatigue, nervousness,emotional incentives before symptom onset.2Compared with old AMI patients, the single-vessel coronary disease is morecommom in the young patients, with little calcification and collateralcirculation. Higher success rate of primary PCI, fewer complications, betterheart function were found in the young patients. |
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