| Objective:To analyze the risk factors,coronary characteristics and prognosis of young patients with acute ST elevation acute ST segment elevation myocardial infarction（STEMI）and further explore the treatment of STEMI.Methods:A total of 120 young patients age<（WTO）with STEMI were admitted in the Second Department of Cardiovascular Hospital of Jilin University from January 2019to December 2020.Non-non-AMI patients who came to our health examination during the same period were selected and matched with 120 young STEMI group by sex and age 1:1,forming the young non-STEMI group.A total of 176 patients clearly diagnosed with the first STEMI and aged 45-75 years were selected as the middle-aged and elderly STEMI group.The hospital case data of all the enrolled patients were collected,and whether the risk factors,the characteristics of coronary lesions and the prognostic indicators were significantly different between the groups were compared.Statistical analysis was performed by using the statistical software,version SPSS25.0.Measurement data are expressed by mean±standard deviation,t-test for comparison between two groups and count data rate~2Tests or nonparametric rank-sum tests were compared.A P<0.05 was considered statistically significant.Meanwhile,logistic regression analysis,ROC curve prediction and survival analysis were used.Results:1.Comparison of demographic and medical history data:There were 120 young patients in the first STEMI group,including 116 males,accounting for 96.7%.Compared with the young non stmei group,there were significant differences in BMI,hypertension,diabetes,smoking history and early-onset family history of coronary heart disease among young patients with first-episode acute stmei（P<0.05）.There were significant differences in the history of coronary heart disease and family BMI between the middle-aged group and the young group（P<0.05）.2.Comparison of laboratory data,There were significant differences between young STEMI and young non-STEMI groups in total cholesterol,triglycerides,high-density lipoprotein,low-density lipoprotein,lipoprotein A,and hypersensitivity C reactive protein,and no significant differences in mean red thin width,mean platelet volume,total bilirubin,direct bilirubin,indirect bilirubin,creatinine,urea nitrogen,uric acid,and homocysteine.Significant differences existed between young STEMI and elderly STEMI groups,including in total cholesterol,triglycerides,HDL,total bilirubin,indirect bilirubin,lipoprotein A,uric acid,BUN,mean red blood cell width,and mean platelet volume,but not in LDL,direct bilirubin,creatinine,hypersensitivity C-reactive protein,and homocysteine.3.For the risk factors in young STMEI and non-STMEI patients,multivariate logistic regression analysis found that smoking,diabetes,family history,low level,HDL,LDL,lipoprotein A and hypersensitivity C reactive protein had no significant risk factors,while hypertension,high cholesterol and high triglycerides.4.Through the ROC curve to predict and analyze the risk factors,it is found that lipoprotein A and high-sensitivity C-reactive protein can be used as the predictors of young first-episode STEMI patients for further research.5.Characteristics of coronary artery disease:through statistical analysis,the coronary artery disease in the young STEMI group was mainly single vessel disease,while the middle-aged and elderly STEMI group was mainly double vessel disease,the difference was statistically significant（P<0.05）.As for criminal vessels,there was no significant difference between young stmei group and middle-aged and elderly STEMI group.The left coronary artery was the main artery,followed by the right coronary artery.Young STEMI patients with coronary artery disease and high load thrombosis were more common than middle-aged and elderly stmei patients,and the difference was statistically significant.6.Prognosis of young patients with first STMEI:1)post-admission cardiac function score（Killip grade）and postoperative cardiac color ultrasound suggested that young first STMEI group had better cardiac recovery and better cardiac function compared with middle-aged STMEI patients（grade Killip I 63.3%vs 42.0%,ejection fraction 61.05±8.09%vs 55.13±9.57%）.2)The incidence of hospital adverse cardiovascular outcomes in young STMEI group was lower than that in middle and old STMEI group,and middle and elderly STEMI patients were more likely to develop serious complications such as heart failure,arrhythmia,ventricular tumor and bleeding.3)The incidence of adverse cardiovascular events in the young STMEI group was also lower compared to the elderly STMEI group.There were statistical differences in mortality,heart failure,and serious complications.4)The survival analysis of young STEMI and STMEI groups showed that young first STMEI patients occurred later（5.00>4.225）compared with middle and elderly STMEI patients,and the probability of adverse cardiovascular events was low,and the difference was statistically significant.Conclusions:1.Young first-episode STEMI patients are mainly male.High BMI,hypertension,diabetes,smoking history,family history of early-onset coronary heart disease,high cholesterol,high triglyceride,high and low density lipoprotein,high lipoprotein A and low and high density lipoprotein may be the risk factors of young STEMI.2 Lipoprotein A and high-sensitivity C-reactive protein can be used as predictive risk factors for young patients with first-episode STEMI.3.This study shows that the coronary artery lesions of young patients with first-episode STEMI are mainly single vessel lesions,and the criminal vessels are mainly left anterior descending artery,and the state of high thrombus load is more common than that of middle-aged and elderly patients with stmei.4.Young patients with first-episode STEMI have relatively short hospital stay,better postoperative cardiac function,lower mortality and adverse cardiovascular events in hospital and 6 months after discharge,and may have a better prognosis than middle-aged and elderly patients with STEMI. |
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