| Objective: A large single-center,premature acute myocardial infarction(AMI)(age(?45 years)cohort was established to investigate the clinical features and the factors affecting Major Adverse Cardiac Events(MACE).Methods:Continuously selected 603 patients with a clear diagnosis of AMI admitted to the Tianjin Chest Hospital from March 2015 to December 2017.All patients were aged ?45 years old,and a single-center large-sample premature AMI cohort was established.The patient's clinical basic conditions,laboratory indicators,imaging data,coronary angiography and treatment;and an average follow-up of 1 year,recorded the occurrence of MACE(including cardiac death,recurrent AMI,revascularization,serious Heart failure requiring hospitalization and stroke),to investigate the clinical features and gender differences of premature AMI.COX regression analysis was used to analyze the influencing factors of MACE in patients with premature AMI,and the survival curve was drawn by Kaplan-Meier method.Results:1.Clinical features of the premature AMI cohort and comparison between the male and female groups:A total of 603 cases were studied,including the male group(n=575,95.36%)and the female group(n=28,4.64%).1.1 Comparison of general conditions:The age of premature AMI was 41(37,44)years old.Smoking was the most common risk factor for premature AMI(77.45%),Followed by hyperlipidemia(48.42%),hypertension(48.09%);422(69.98%)patients with STEMI,181(30.02%)patients with NSTEMI,and 206(48.82%)patients with STEMI were anterior myocardial infarction;The male group had a significantly higher smoking history and drinking history than female patients [smoking history: male group 80.35% vs female group 17.86%,p<0.001;drinking history: male group 42.43% vs female group7.14%,p<0.001].1.2 Comparison of Heart Doppler ultrasound and laboratory indicators:(1)Heart Doppler ultrasound: the left atrial diameter and left ventricular end-diastolic diameter(LVED)of the male group was significantly higher than that in the female group [left atrial diameter: male group 37.00(34.00,39.00)vs female 32.00(30.00,36.00),p<0.001;left ventricular end-diastolic diameter LVED: male group 52.00(50.00,55.00)vs female group 47.50(45.00,50.00),p<0.001];(2)Laboratory indicators: The levels of UA,Cr,Hcy,TG,VLDL in male group were higher than those in female group,while the levels of CK-MB max,BNP max,HDL and APOA were lower than those in female group.1.3 Comparison of coronary angiography and treatment:(1)Coronary angiography: 563(93.37%)patients underwent coronary angiography,and coronary angiography showed that no significant stenosis,single-vessel disease,double-vessel disease,three-vessel disease,and patients with left main disease were 15(2.66%),212(37.66%),153(25.37%),167(29.66%),16(2.84%)cases;318(56.48%)patients with vascular occlusion;The proportion of male combined with left main lesions was lower than that of female group [2.41% in male group and 12.50% in female group,p=0.026];(2)Treatment: 302(50.08%)patients with premature AMI were treated with Symptom onset to first medical contact(SO-to-FMC)? 12h;within 24 hours of admission,antiplatelet(98.51%),condensate(97.18%)and lipid-lowering(95.69%)were given.Treatment;the proportion of patients receiving primary PCI,elective PCI,thrombolysis,elective CABG and conservative treatment in STEMI patients respectively were 47.39%,39.10%,2.13%,0.71%,10.66,,of which D to B time for primary PCI was 74.26±24.72min;the proportion of patients receiving primary PCI,elective PCI,elective CABG and conservative treatment in NSTEMI patients respectively were 8.84%,62.98%,4.42%,23.76%;The proportion of STEMI patients receiving PCI in the male group was higher than that in the female group [87.31% in the male group vs 70.00% in the female group,p=0.040],and the proportion of patients receiving conservative treatment was lower than that in the female group [9.95% in the male group vs25.00% in the female group).p=0.033];1.4 Comparison of clinical outcomes:A total of 603 patients were enrolled in this study.The average follow-up was 1 year.31 patients were lost to follow-up.The follow-up rate was 94.86%.A total of 45 patients(7.46%)were recorded MACE,including 7 patients with cardiac death(1.16%)and recurrent AMI 11 In the case of(1.82%),27 patients(4.48%)underwent revascularization,7 patients(1.16%)had serious Heart failure requiring hospitalization,and 4 patients(0.66%)had stroke.The 1-year MACE incidence was lower in the male group than in the female group[Male group 6.96% vs female group 17.86%,p=0.032],and the difference was statistically significant.2.Analysis of risk factors for MACE in patients with premature AMI within 1year(1)Univariate COX regression analysis:The following 20 indicators were statistically significant: female,BMI,history of angina,history of myocardial infarction,history of CABG,systolic blood pressure at admission,heart rate at admission,Killip grade ? 2,LVEF ? 40 %,CK-MB max,BNP max,Cr,Hcy,CRP,LDL,APOB,FBG,three-vessel disease,SO-to-FMC ? 12 h,hospitalization days were associated with MACE within 1 year of early-onset AMI patients;(2)Multivariate COX regression analysis: There were 5 indicators that entered the regression model and were statistically significant: female [HR: 4.184;95% CI: 1.583-11.064;p=0.004],SO-to-FMC ? 12 h [ HR: 0.447;95% CI:0.224-0.889;p=0.022],LVEF ? 40% [HR: 3.727;95% CI: 1.876-7.405;p<0.001],LDL [HR: 1.315;95% CI: 1.041-1.662;p=0.022],Hcy[HR: 1.011;95% CI:1.002-1.019;p=0.011] are independent predictor of MACE occurrence in patients with early-onset AMI within 1 year.3.Kaplan-Meier survival curve of MACE in patients with early-onset AMI within1 year The rate of revascularization was the highest in patients with premature AMI who were followed up for 1 year,and all cardiac deaths occurred in the early(30days).Conclusion:1.In premature AMI patients,male vs female is 20:1,mainly male,smoking is the most common risk factor,followed by hyperlipidemia,hypertension;about50% of patients get first medical contact within 12 hours after symptom onset,most patients with coronary artery disease have vascular occlusion The proportion of single-vessel disease is higher;the proportion of STEMI is70%,mainly involving the anterior wall,and the proportion of patients receiving direct PCI is higher;2.The incidence of MACE in patients with premature AMI is 7.46%,and the incidence of central death is lower(1.16%).Women and the patients with LVEF?40%,high LDL and high Hcy had a poorer prognosis.Patients who get first medical contact within 12 hours had a better prognosis. |
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