Clinical Manifestations Of Young And Middle-aged Patients With Acute Myocardial Infarction

Morbidity and mortality rates of Atherosclerosis (AS) showed an upward trend year after year, which became a serious threat to human health. Among it, the mortality rate of AMI is higher and more dangerous. As is worthy of our attention, in recent years, with the improvement of people's living standards and the increasing job stress, AMI incidence trends to appear younger. Young and middle-aged have played an important role at all levels of society as the main productive forces of contemporary society. So, the prevention and treatment of young and middle-aged with AMI is particularly important. From the clinical work we found that young and middle-aged acute myocardial infarction differ from the old at risk factors, onset characteristics, biochemical parameters, colorful Doppler ultrasound of the heart and cardiac complications. It's very useful to Detect and analyze these differences, which can help us in clinical works and the prevention of the occurrence of middle-aged and young with AMI. The course of the study are as follows:1,case selection and the packet Research for 100 young and middle-aged patients (age < 60 years)ith confirmed AMI who required medical treatment between January 1, 2007 and December 31, 2008 in the First Hospital of Jilin University, 86 cases of whom are males, the average age was 48.8±8.5 years; choose 93 cases of confirmed AMI in elderly patients (age≥60 years) in the same period of hospitalization as a control group, of which 58 cases are males, the average age was 68.8±5.5 years old. Inclusion criteria: (1) has the typical symptoms of AMI; (2) there is a typical AMI ECG dynamic evolution of graphics; (3) enzymes and markers of myocardial injury are consistent with the diagnostic criteria for AMI and showed dynamic changes; (4) coronary angiography confirmed acute AMI. The patients who meet (4) and the other two cases at the same time can be selected arbitrarily. Exclusion criteria: (1) fail to record the basic information; (2) have not received the colorful Doppler ultrasound examination of heart in hospital; (3) lack of any the biochemical tests during the hospital stay, including blood, renal, myocardial, markers of myocardial injury, blood lipids, fasting blood glucose; (4) hospitalized with acute renal failure, acute liver failure,severe infection and in patients with malignant. The patients are divided into two groups according to age: young and middle-aged group (<60 years) contains 100 cases, of which 86 cases are male, 14 cases are female and the average age is 48.8±8.5 years; old age group (≥60 years) contains 93 cases, of which 58 cases are male, 35 cases are female and the average age is 68.8±5.5 years old. 2,the target of the records and statistical methodsRecord all the research and general information on the traditional risk factors for AMI: including age, sex, hypertension, diabetes, hyperlipidemia, smoking, positive family history, drinking and so on. And record the number of risk factors for each patient. Record all the onset characteristics of subjects: including the onset of symptoms, accompanied symptoms, previous history of chest pain and infarction area. We also record two epidemiological datas: The patient place of residence (rural or urban) and the season of the incidence. Record conventional biochemical indicators: including blood [including the total number of peripheral white blood cells (WBC), percentage of neutrophils (N), hemoglobin (HB)], fasting blood glucose (FBG), blood lipids [including TC, TG, HDL-C, LDL-C, LP-a], renal [including peripheral blood creatinine (Cr) and blood urea nitrogen (BUN)], the first time admitted enzymes [including creatine kinase (CK), lactate dehydrogenase (LDH), aspartate aminotransferase (AST), lactate dehydrogenase isoenzyme 1 percentage (LD1)], the first admission of myocardial injury markers [troponin I (TnI), myoglobin (Mb), mixed-type creatine kinase isoenzyme (CK-MB) mass]. Record hospital cardiac color Doppler ultrasound test results: the size of the heart chamber [including left ventricular (LV), right ventricular (RV), left atrium (LA)]; left ventricular ejection fraction (EF); valve regurgitation (including mitral, tricuspid, aortic valve, pulmonary valve); weakening or disappearance of wall pulsation; left ventricular hypertrophy; septal hypertrophy; septal thinning; pericardial effusion. Record the results of coronary angiography: including the location and severity of disease. The location includes the left main lesion (LM), left anterior descending artery (LAD), LCX and right coronary artery (RCA), any one of which to reduce the diameter of≥50% lesion is judged to be meaningful. Involved only one vascular lesions is considered as a single, two or more affected as many vascular lesion. Record complications occurred in hospital: including cardiogenic shock, arrhythmias, heart failure and aneurysm formation. We use SPSS13.0 software to analys the data; count data usingχ2 test; for data in line with the normal distribution of measurement in order to express X±s, the two samples of the use of homogeneity t test, variance using missing t 'test; for data not in line with the normal distribution of measurement data, we use non-parametric test; P<0.05 as statistically significant difference; P<0.01 for the difference was significant.3,The resultsFirst, the risk factors: smoking rate in middle-aged and young group of AMI was significantly higher than the proportion of the elderly group. Hyperte- nsion and diabetes in young and middle-aged in the incidence of AMI must be less than the older group. Young and middle-aged with AMI are almost males. The differences of alcohol, hyperlipidemia and positive family history between the two groups was not significant.Second, onset characteristics: middle-aged and young AMI patients with previous history of chest pain were significantly lower than the older group, and the main place of residence was in the rural areas. The differences of seasonal of incidence, infarction area, onset of symptoms and associated symptoms between the two groups of patients were not statistically significant.Third, biochemical target: the total number of peripheral white blood cells, hemoglobin values, TG values of young and middle-aged patients with AMI were higher than the older group. The FBG and the BUN was significantly lower than the value of the old age group. The differences of Enzymes and markers of myocardial damage between the two groups were not statistically significant.Fourth, results of cardial colorful Doppler ultrasound examination: mitral regurgitation and aortic valve regurgitation in young and middle-aged patients with AMI were significantly lower than the proportion of the elderly group. The difference of the heart size, left ventricular ejection fraction and other aspects between the two groups were not statistically significant.Fifth, coronary angiography: the difference of vascular lesions and lesions in the count between the two groups were not statistically significant.Sixth, complications: aneurysm and arrhythmia in middle-aged and young with AMI were significantly lower than the proportion of the elderly group. Other complications'differences between the two groups were not statistically significant.4,the significance of this study and enlightenmentFirst, young and middle-aged patients with AMI has their own unique characteristics in risk factors: smoking is an important and independent risk factors for middle-aged and young with AMI that can be changed, so it has an extremely important significance for the prevention of AMI of young and middle-aged to quit smoking. With regard to gender, male dominated in young and middle-aged patients with AMI. Hypertension and diabetes are not important risk factors for the young and middle-aged patients with AMI.Second, most middle-aged and young patients with AMI live in rural areas, and the rate of the history of the chest pain was relatively fewer, which indicated that the incidence of young and middle-aged patients with AMI was sudden and sharp, and its incidence is directly related to the nature and intensity of their labor.Third, WBC,hemoglobin values and TG values were higher in middle-aged and young patients with AMI ,from which we could infer that the incidence may be related to the above-mentioned increase in biochemical indicators.Fourth, middle-aged and young patients with AMI had better prognosis, fewer complications than the older group, which could have a positive significance for the guidance of our clinical treatment.