Risk Factors And Clinical Characteristics In Young Patients With Acute Myocardial Infarction

Objective To analyze the risk factors and clinical characteristics of young patients(?44 years old)with acute myocardial infarction(AMI).To explore the prevention and treatment of AMI in young patients.Methods We collected data on 279 consecutive young patients(?44 years old)diagnosed AMI by coronary artery angiography as young AMI group,279 healthy people by age-and sex-matched(±1 year old)with young AMI patients as young non-AMI group.And 889 patients(?60 years old)diagnosed with AMI were as elderly group.All patients were admitted to the First Affiliated Hospital of Soochow University from January 2012 to December 2017.Medical history information,biochemical indicators were compared respectively between case group and control groups.And symptom,coronary angiography findings,complications and prognosis were compared between young AMI group and elderly AMI group.SPSS 24.0 was used for data analysis.Results 1.The study included 269 male(96.4%).The ratio of hypertension,diabetes,smoking,family history of premature coronary heart disease,the level of body mass index(BMI)?triglyceride(TG)?total cholesterol(TC)?low-density lipoprotein cholesterol(LDL-C)?Lipoprotein(a)(Lp(a))in young AMI group were higher than that of the young non-AMI group(P<0.05).The level of high-density lioprotein cholesterol(HDL-C)?total bilirubin(TBil)?direct bilirubin(DBil)?indirect bilirubin(IBil)in young AMI group were lower than that of the young non-AMI group(P<0.05).2.Conditional logistic regression analysis showed that smoking(OR=2.241,95%CI:1.677-2.993)was the most significant independent risk factor of AMI in young patients,followed by was LDL-C(OR=1.163,95%CI:1.034-1.308).HDL-C(OR=0.543,95%CI:0.341=0.86),DBil(OR=0.899,95%CI:0.856-0.943)were independent protective factors.3.In the young AMI group,the ratio of hypertension diabetes and the level of TC,LDL-C,Lp(a)were positively correlated with the number of coronary artery lesions,while the TBil,DBil were negative correlated with the number of coronary artery lesions.(P<0.05)4.The distribution of controllable risk factors was different between young AMI group ang young non-AMI group,and risk factors' aggregation were widespread in young AMI patients.93.2%of young AMI patients have 2 or more controllable risk factors.The ratio of patients with less than 3 risk factors was lower(21.5%VS 60.9%),and the ratio of patients with more than 3 risk factors was higher(44.1%VS 25.3%)in young AMI group than that in young non-AMI group(P<0.05).5.The ratio of male,smoking,family history of premature coronary heart disease,the level of BMI,TC,TG,LDL-C in young AMI group were higher than that of elderly group(P<0.05).The ratio of hypertension,diabetes and the level of serum creatinine(Scr),HDL-C,Lp(a)were lower than the elderly group(P<0.05).There was no difference between the two groups in the ratio of drinking and the level of UA,TBil,DBil,IBil(P>0.05).6.For young AMI patients,the time of from the onset of symptoms to admission was shorter than that of elderly AMI group(P<0.05).The ratio of angina and Killip>2 were lower in young AMI group than that in elderly AMI group(P<0.05).There was a higher ratio of ST-elevation myocardial infarction(STEMI)in young AMI group than that in elderly AMI group(70.3%VS 63.0%,P<0.05).The main symptom was pectoralgia both in two groups(83.9%VS 75.3%),and the ratio of pectoralgia in young AMI patients was higher than elderly AMI patients(P<0.05).The ratio of syncope,atypical presentation were lower in young AMI group than that in elderly AMI group(P<0.05),The level of TnT and CK-MB were higher in young AMI patients than those in elderly AMI group(P<0.05).The ratio of single vessel disease in young AMI group was higher than those of the elderly group(P<0.05).Cardiac ultrasound showed the level of ejection fraction(EF)was higher in young AMI group than that elderly AMI group and the level of left ventricular end-systolic dimension(LVSD)and left atrial inner diameter(LA)were lower in young AMI group than that elderly AMI group(P<0.05).7.Coronary angiography showed the ratio of single vessel disease in young AMI group was higher than that of the elderly AMI group(P<0.05).According to the infarction related artery,the ratio of left anterior descending artery(LAD)was significantly higher in young AMI group than that of the elderly AMI group.For both young AMI group and elderly AMI group,the left anterior descending artery was involved frequently(68.1%VS 72.3%),but there was no significant difference(P>0.05).The ratio of high thrombus burden in young AMI group was higher than that of elderly AMI group(P<0.05).8.The mortality in 1-month was lower in young AMI group than that in elderly AMI group(0.07%VS 6.3%,P<0.05).The comparison of other complications showed that the incidence of heart failure,pulmonary infection and arrhythmia in the young AMI group were lower than those in the elderly patients(P<0.05).Conclusion The majority of AMI in young patients were male.Smoking and LDL-C were significant independent risk factors of young AMI patients,HDL and DBil were significant protective factors of young AMI patients.Risk factors' aggregation were widespread in young AMI patients.The main symptom in young AMI group was pectoralgia.The main type of AMI was STEMI.The coronary angiography was mainly a single lesion and the left anterior descending artery lesion dominated.1-month mortality and complications in hospital were less or lower in young AMI than elderly AMI group.