| Objective:With the improvement of living conditions,the incidence of acute myocardial infarction(AMI)in young people is on the rise.The AMI of young people is a group of fatal diseases with urgent conditions,which has caused a heavy pressure on society and the family.Therefore,it is extremely important to predict and evaluate the occurrence of cardiovascular adverse events in young people with AMI.Studies have shown that mean platelet volume(MPV)is closely related to the occurrence of cardiovascular disease and poor prognosis.However,at present,most of the AMIs we know are from elderly patients.There are few domestic studies on youth AMI.Therefore,we focus on the diagnostic value of MPV levels in young adults with AMI,analyze the correlation between MPV levels and coronary lesions in young AMI patients,and evaluate the value of MPV levels in the prognosis of young patients with AMI.In order to better risk stratification and to assess short-term prognosis of young AMI patients.Method:According to the third edition of the Global Cardiac Infarction Diagnostic Criteria developed by the European Journal of Cardiology in 2012,174 patients with AMI who were ?45 years old was selected to young AMI group in our hospital from January 2016 to June 2018?There were 166 males and 8 females,with an average age of 40±5 years.randomly selected from the same period 108 AMI patients with age of >45 years as elderly AMI group,68 males and 40 females,with an average age of 61±9 years.In the same period,79 patients younger than 45 years with normal coronary arteries diagnosed by coronary angiography or coronary CTA were selected as the normal group,64 males and 15 females,with an average age of 40±4 years.The information of all the selected patients were collected,including general information,laboratory examination,coronary angiography results.Exclusion criteria:(1)The patient's chest pain time was >12h.(2)Patients with stroke,cardiacfailure,atrial fibrillation,congenital heart disease,severe heart failure,cardiomyopathy,and myocarditis at admission;(3)The patient treatment with aspirin,clopidogrel,warfarin,heparin at admission;(4)The patient with the history of acute and chronic hemorrhage,Hematological Disease,severe infection,hypertrophic cardiomyopathy,severe hepatic insufficiency,malignant tumors,Long-term use of immunosuppressive agents,blood transfusion within 1 month;(5)Patients with a history of coronary intervention or coronary artery bypass;(6)admission data were missing or unavailable.MPV was detected in all patients within 120 min.And give medications according to the corresponding guidelines,including antiplatelet drugs,anticoagulants,statins,? blockers and angiotensin converting enzyme inhibitors(ACEI)or angiotensin receptor blockers(ARB).MPV levels were recorded for all patients and gensini scores were calculated for all young AMI patients.According to the results of coronary angiography,the young AMI group was divided into single-vessel disease group,double-vessel disease group and three-vessel disease group.Quantitative assessment of coronary artery lesion stenosis was performed according to gensini score in young AMI group.Patients with AMI were followed up for at least 6 months to enroll patients with The occurrence of major cardiovascular adverse events(MACEs)after discharge(including cardiac death,revascularization of target vessels,nonfatal myocardial infarction,heart failure,or angina re-admission).All analysis were performed by statistical software,and count variable was expressed using frequency,and was compared by the chi-square test.Quantitative variables were expressed as mean value ± standard deviation,and Wilcoxon rank test was used to compare the differences between the two groups.The correlation between MPV and other clinical and laboratory parameters was analyzed using Spearman correlation.Logistic regression was used to perform variable univariate and multivariate analysis,and variables with univariate analysis significance were placed in a multivariate model.The receiver operating curve(ROC)of the MPV was plotted and the area under the curve(AUC)was compared.P ? 0.05 was considered statistically significant.Results:1.Compared with the general clinical data and laboratory indicators of AMI in younger and elderly people:age,gender,smoking,BMI,platelet count,WBC,TG,uric acid,creatinine and BUN between younger people and elderly people were statistically significant differences.Compared with the normal group,gender,smoking,diabetes,BMI,TC,LDL-c,TG,platelet count,WBC and Hs-CRP were significantly higher than young patients without AMI,and HDL was significantly lower than young patients without AMI(P<0.05).2.The MPV level of the young AMI group was higher than elderly AMI group(9.3±1.2 VS 9.0±1.3,P<0.05)and the young normal group(9.3± 1.2 VS 8.9± 1.0,P<0.05),the difference was significant.Further multivariate logistic regression analysis adjusted for other factors and showed that MPV was an independent risk factor for young patients with AMI.3.ROC curve analysis of the prediction of MPV level in young patients with AMI showed that the area under the curve(AUC)of MPV was 0.605(95% Cl0.532-0.677),Cut-off values was 9.45 fl,and The sensitivity and specificity were0.460 and 0.785.4.Spearman correlation analysis showed that the MPV was associated with Gensini score.(r = 0.163,p < 0.05).There was no correlation with the number of coronary artery lesions.5.Compared with the low MPV group and the high MPV group,the incidence of MACE in the high MPV group was higher than that in the low MPV group,and the difference was statistically significant(P=0.002).Conclusion:1.MPV is an independent risk factor for AMI in young people.2.MPV level can be used as a predictor of AMI in young patients.3.MPV levels correlate with the severity of coronary artery disease in young AMI patients.4.MPV level can be used as a predictive indicator of short-term(6 months)MACEs events in young AMI patients,which has certain prognostic value. |
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