| Background:Acute myocardial infarction(AMI)is one of the most serious diseases that are threatening human health all over the world because of its rapid onset,dangerous condition,many complications and serious impact on the quality of life of patients.According to the latest China Cardiovascular Disease Report,there are over one million people suffering from acute myocardial infarction every year in China.In recent years,the incidence of AMI in middle-aged and young people(younger than 60 years old)has been increasing quickly.Young and middle-aged people are the mainstays of family and society.AMI among young and middle-aged people not only seriously affects their quality of life,but also threatens the happiness of family and society.This deserves our attentionObjective:The purpose of this study is to compare and analyze the differences of clinical characteristics between young&middle-aged patients and old patients with acute myocardial infarction(AMI)and to explore the main risk factors of AMI in people of different ages,which can provide basis for clinical treatment.Methods:866 patients with acute myocardial infarction who were operated in the Department of Cardiology of the first people's Hospital Affiliated to Soochow University from January 2016 to January 2018 were collected.According to their ages,they were divided into the young and middle-aged group(age<60)as the experimental group and the old group(age?60)as the control group.The basic clinical data,laboratory test indexes,CAG conditions,Treatment during hospitalization,and complications,etc of the two groups were compared and analyzed with statistical methods.According to the Gensini score of patients,the classified grade data(1,2,3)was used as the dependent variable,and the laboratory indexes and risk factors were used as the independent variables for logistic regression analysis.Differences whose P<0.05 were statistically significant.Results:1.866 patients were selected and divided into young and middle age group(400 cases,48.2 ± 7.2 years old)and old age group(466 cases,69.7 ± 8.1 years old).The proportion of young and middle-aged women(9.3%vs 22.7%),hypertension(46.2%vs 65.9%),diabetes(17.8%vs 24.3%),atrial fibrillation(1.8%vs 5.4%),stroke(2.5%vs 5.2%)were lower than that of the old group;the proportion of hyperlipidemia(61.8%vs 42.5%),smoking(74.9%vs 55.8%),coronary heart disease family history(17.0%vs 8.2%),overweight in the young and middle-aged group were higher than those in the old group(42.3%vs 10.3%).The diastolic blood pressure(79.32±14.63 vs 74.07±14.55)of the young and middle-aged group was higher than the old group.2.White blood cell count(×109/L)(7.87 ± 3.98vs7.32±3.77),platelet count(×109/L)(203.33±81vs1 83.21 ± 79.05),total protein(g/L)(65.35±7.66vs64.02±5.97),prealbumin(mg/L)(205.29±52.29vs182.66±52.68),total cholesterol(mmol/L)(4.68±1.12vs4.4 ± 1.05),triglyceride(mmol/L)(1.83±1.25 vs 1.31),low density cholesterol(mmol/L)(2.99 ± 0.97 vs 2.76 ± 0.9),Left ventricular end systolic diameter(mm)(38.28±5.49 vs 37.99 ± 5.95)in the middle and young group were higher than those in old group.Urea(mmol/L)(5.12 ± 2.15vs6.16±2.95),adenosine deaminase(U/L)(10.68 ±3.97vs12.02 ± 4.59),high-density cholesterol(mmol/L)(1.05 ± 0.22vs1.14 ± 0.25),prothrombin time were higher than those in the old group(sec)(11.62 ± 1.57 vs 12.37 ±2.64)and fibrinogen(g/L)(3.04±0.89 vs 3.2±0.94)in the middle and young group were lower than those in the old group.3.The number of coronary artery lesions in the young and middle-aged group was less than that in the old group,and patients with single vessel disease accounted for the biggest part in the two groups,and the proportion of single vessel lesions in the young and middle-aged group was higher than that in the old group(56.7%vs 48.7%);the proportion of two vessel lesions and three vessel lesions in the young and middle-aged group was lower than those in the old group;the Gensini score in the young and middle-aged group(50.27±27.24 vs 78.38±37.35)was lower than that in the old group.The proportion of MACE(18%vs 25.8%),heart failure(14.0%vs 27.7%)and ventricular aneurysm(5.1%vs 8.7%)in the young and middle-aged group were less than those in the elderly.There was statistical difference between the two groups in different Killip grades,the middle-aged and young patients showed a lower grade than the elderly.There was no significant difference between the two groups in treatments during the stay in hospital.4.There were significant differences in the proportion of hyperlipidemia,smoking,family history of CHD,SBP,DBP,TB,LDL-C and LVEF among different Gensini score grades in the young and middle-aged group.The main risk factors were smoking(OR=9.345,95%CI=[0.567,5.305]),high LDL-C(OR=7.890,95%CI=[0.341,4.546]),high TC(OR=3.789,95%CI=[0.456,3.364]),family history of coronary heart disease(OR=2.786,95%CI=[0.341,1.581]).5.There were significant differences among different Gensini score grades in the old group in the history of hypertension,diabetes,coronary heart disease family history,fasting blood-glucose and total bilirubin.The main risk factors were diabetes(OR=6.738,95%CI=[0.547,4.153])and high FBG(OR=2.789,95%CI=[0.167,1.987]).Conclusion:1.There are different clinical characteristics between the young and middle-aged group and the old group in gender ratio,chronic disease ratio,blood lipid,number and severity of coronary lesions,complications after PCI and so on.The prognosis of young and middle-aged group was better than that of old group.2.The risk factors of coronary artery disease were different between the young and the old group.In young and middle-aged group,smoking was the most significant risk factor of acute myocardial infarction,the rest were high LDL-C,high TC,low TB and family history of CHD.The severity of coronary artery disease was positively correlated with LDL-C and TC concentration,and negatively correlated with total bilirubin.In the old group,diabetes and high FBG were the risk factors of coronary artery disease,among which diabetes was the primary risk factor.There was a positive correlation between coronary artery disease and FBG concentration in the old group.3.The elderly should improve their treatment compliance,pay attention to and control the development of diabetes.For young people,improving the bad life style and avoiding overwork are the key links to prevent and treat coronary heart disease.In order to reduce the incidence of AMI,we should actively carry out primary prevention,especially for the healthy young and middle-aged people with obesity,dyslipidemia and family history of CHD. |
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