| Objective: This study aims to explore the clinical characteristics,diagnosis and treatment methods and risk factors of patients with acute myocardial infarction(AMI)in different age groups through the differences in cardiovascular risk factors,laboratory indicators,treatment strategies,vascular lesions,complications and adverse events,so as to provide potential theoretical basis for the treatment and prevention of AMI patients.Methods: A total of 1463 patients with AMI in our hospital from January 2015 to December 2017 were retrospectively collected.The patients were divided into young group(18-44 years old)298 cases,middle-aged group(45-59 years old)354 cases,old group(60-74 years old)616 cases and old group(>75 years old)195 cases.Cardiovascular risk factors and laboratories were analyzed.The laboratory indicators,treatment strategies,coronary artery lesions,complications and hospital outcomes were analyzed and compared.Results:(1)With the increase of age,the proportion of males in AMI patients decreased gradually(93.95% / 94.35% / 75.16% / 63.07% in young / middle-aged / old / old group,respectively,P < 0.001).The proportion of smoking decreased significantly with the increase of age(69.80% / 64.41% / 34.58% / 22.56 in young / middle-aged / old group,P < 0.004).The drinking rate of middle-aged patients was significantly higher than that of the other three groups.Group A(young group/middle-aged group/old group/old age group: 28.19%/39.83%/8.60%/10.26%,P < 0.001),the proportion of alcohol consumption decreased significantly with age.(2)There were significant differences in the proportion of hypertension,diabetes mellitus,coronary heart disease,dyslipidemia,stroke and TIA history among different age groups(P < 0.05).The prevalence of hypertension increased with age(13.76% / 38.42% / 47.08% / 48.21%,P < 0.001)and diabetes(6.04% / 15.54% / 22.89% / 29.74%,P < 0.001).The incidence of coronary heart disease also increased in the past(young / middle-aged / elderly / elderly group).Aged group: 0.34% / 4.52% / 5.03% / 13.85%,P < 0.0001,and there was a linear correlation with age.Among different age groups,there was no significant linear correlation between dyslipidemia(youth group/middle-aged group/old group/old group: 1.34%/10.73%/18.51%/3.59%,P < 0.001),stroke and TIA incidence(youth group/middle-aged group/old group/old group: 0%/4.55%/3.59%,P < 0.001)and age,but there was significant difference between groups.(3)According to the relevant situation of admission,there are statistical differences in emergency admission rate and referral rate among different age groups.The 120 emergency admission rate in middle-aged group is the lowest,while the elderly group has the highest emergency admission rate.The difference is statistically significant(12.75% / 8.47% / 14.00% / 21.03% in young group / middle-aged group / old group,P < 0.0001).There was no significant difference in outpatient referral rate between the young and the old groups,but there was significant difference between the elderly group and the middle-aged group(36.58% / 25.14% / 37.82% / 15.90%,P < 0.0001)and the other two groups.Statistical analysis of vital signs at admission showed that the incidence of shock increased gradually(2.01%/1.41%/3.41%/8.72% in the youth group/middle-aged group/elderly group).The incidence of shock in the elderly group was significantly higher than that in the other three groups(P < 0.0001).The proportion of cardiac dysfunction(KILLIP III-IV)in the elderly group was also significantly higher(young group/middle-aged group/elderly group).The age group/elderly group: 3.36%/3.67%/11.69%/22.05%.The difference was statistically significant(P < 0.0001).With the increase of age,the cardiac function of patients with myocardial infarction decreased significantly.The incidence of cardiac dysfunction in the elderly group was higher than that in the other three groups.(4)From the aspects of diagnosis and treatment,pathological changes and complications,the proportion of patients receiving direct PCI treatment decreases with age.The proportion of such patients is 92.28%,97.46%,92.53% and 65.13% respectively.The difference is statistically significant(P<0.0001).The proportion of elderly patients receiving direct PCI treatment is significantly lower than the other three groups.From the number of lesion vessels,the incidence of single vessel disease decreased significantly with age in different age groups(49.45% / 32.73% / 26.49% / 11.02%,P<0.0001).The proportion of double vessel disease was similar among different age groups,with no statistical difference(29.45% / 30.91% / 29.65% / 30.71,P = 0.995).The proportion of three vessel disease increased with age,and the difference was statistically significant(29.45%/30.91%/29.65%/30.71,P=0.995).Significance(21.09%/36.36%/51.58%/53.54%,P<0.0001).The incidence of left main artery disease increased with age(2.18%/2.42%/3.68%/8.66%,P=0.005);the incidence of left anterior descending artery had no significant difference between groups(84.00%/94.12%/89.65%/85.04%,P=0.095);the incidence of left circumflex artery disease was significantly different between groups,the young group did not tend to suffer from left circumflex artery disease,the other three groups were not inclined to suffer from left circumflex artery disease.There was no significant age-related tendency(34.55%/53.33%/47.02%/52.76%,P<0.0001);the incidence of right coronary artery tended to increase with age(46.55%/69.09%/73.68%/63.78%,P=0.014).The younger group did not tend to suffer from right coronary artery disease and the middle-aged,elderly and elderly groups tended to suffer from right coronary artery disease.From the point of view of complications,the elderly patients(the elderly group and the elderly group)tend to have pericardial effusion.The prevalence of pericardial effusion in the young and middle-aged group is not significant(0.34% /2.26% /5.36% /5.13%,P<0.0001);there is no significant difference in the incidence of intracardiac thrombosis among different age groups(1.01% /1.13% /1.95% 0.51%,P = 0.387);the incidence of ventricular aneurysm in different age groups is not significant.There was a significant linear correlation with age,but there was significant difference between the two groups.The elderly group was more likely to develop ventricular aneurysm(11.41%/9.32%/15.10%/6.15%,P=0.014).The probability of gastrointestinal bleeding increased with age(0/0/0.70% 3.14%,P=0.019).There was a big difference between the two groups.(5)According to the auxiliary examination,there was no significant difference between most of the auxiliary examination groups,except RBC,WBC,PLT,CERA and TG(P < 0.05);GRACE score of selected patients increased significantly with age(P < 0.0001).(6)In terms of clinical outcomes,all-cause mortality increased with age,with statistical significance(youth/middle-aged/old/old group: 0.34%/1.98%/5.84%/16.92%,P < 0.0001);the incidence of MACE events increased with age(young/middle-aged/old/old group: 0.67%/1.41%/9.58%/19.49%,P < 0.0001).Logistic regression analysis showed that BMI,stroke or TIA history,GRACE score were significant factors influencing the occurrence of MACE events.CONCLUSION: With the increase of age,the emergency admission rate of 120 patients with AMI gradually increased,cardiac function was poor,complications were more,GRACE score increased significantly,the proportion of patients receiving PCI treatment decreased gradually,the range of coronary artery lesions increased,mainly multi-vessel lesions,the left main lesion rate increased significantly,and the incidence of adverse events increased significantly. |
PDF Full Text Request