| Objectives:The main aim of this study was to determine the clinical characteristics,such as risk factors,presentation,coronary angiographic findings and management of young patients(age= 40 years) with acute myocardial infarction(AMI)in this region compared with elderly patients. The information about these may have an influence on the strategies for prevention,diagnosis and management for acute myocardial infarction in young patients.Methods:This is a retrospective case control study.All case-notes with a discharge or death diagnosis of AMI between January 1999 and January 2009 at the department of cadiology in the 1st Hospital of Shanxi Medical University were reviewed retropectively.All patients(n=218) were categorised into two group according to age.Age less than 40-year-old patients with AMI are defined as youth group(n=106),and those 60-75 years with AMI are defined as elderly group(n=112).Clinical datas(risk factors,incentive,presentation,coronary angiographic findings,laboratory findings and treatment options et al) of the youth group and elderly group were collected and compared.Results:1.Compared to elderly group,the significant differences among all of the risk factors in young adults were:age,sex,family history,history of hypertension,diabetes history,smoking,drinking, height,weight,diastolic blood pressure,pulse pressure,fasting glucose,TG,APOAI,BUN. However there were no significant differences between young group and elderly group in other risk factors such as the history of hyperlipidemia,BMI,systolic blood pressure,heart rate,TC, HDL-C,LDL-C,APOB,APOB/APOAI,Lp(a),Cr,UA,FIB.2.Alcohol-induced myocardial infarction was a unique incentive in the young;the clinical symptoms such as typical chest pain of the young was higher than the older,but there was no significant difference(86.8%vs 77.7%,P＜0.05).The most common wall of AMI in youth group is anterior wall,and there was a significant difference compared to elderly group(50.0%vs 37.8,P=0.033).3.In all selected cases,the proportion of coronary angiography in the youth group was 65.1%,and the elderly group was 35.7%,compared with the two group,there is statistically significant difference,P＜0.05.Single-vessel lesion in the youth group(58.8%) was significantly higher than the elderly group (13.3%),P＜0.05.The diffuse lesions changes(7.6%) was significantly less than the elderly group(34.2%),P＜0.05.the formation of collateral circulation in the youth group was less than the elderly group,and there was a significant difference(11.9%vs 22.5%,P＜0.05)between them. Among all coronary artery in young patients left anterior descending artery(LAD) was most vulnerable to involved(56.63%),followed by were the right coronary artery(33.73%),left circumflex branch(9.64%),no left main artery was involved(0%).In elderly AMI group the most vulnerable was left anterior descending artery(LAD) involved(32.29%),followed by were the right coronary artery(31.25%),left circumflex branch(26.04%),left main artery(10.42%). There were significant differences between two groups except RCA.For young patients with AMI LAD was more easier involved,and for the olds LCX and LM were more easier involved.The coronary artery scores of youth group were significantly higher than that of the edder group (23.69±22.80 vs 39.21±40.37,P＜0.01).Multivariate linear stepwise regression analysis showed that smoking index,Lp(a) and hypertention were independent facts for coronary artery Gensini's scores in the young patients with acute myocardial infarction.The size of the contribution of these three indicators to coronary artery scores were as follows:high blood pressure＞Lp(a)＞Smoking index.The thrombolytic therapy and thrombolytic therapy+selective PCI in the young were significantly higher than the elder,P＜0.01.Conclusion:1.There were few risk factors of AMI for young people,the majority of them were lack of hypertention,diabetes mellitus and other risk factors.For young people alcohol abuse may be the important causes of AMI,its clinical manifestations was typical,treatment was positive,and the rate of thrombolytic therapy and stenting surgery was higher than the elderly.2.For the youth group,single vessel coronary was involved most frequently,and the left anterior descending artery was the most frequently involved vessel,the diffuse vascular lesions were more rare,formation of collateral circulation were more less.3.Smoking index,Lp(a) and high blood pressure were independent facts for coronary artery Gensini's scores in the young patients with acute myocardial infarction.
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