年龄小于 45 岁与大于 45 岁急性 ST 段抬高型心肌梗死患者的危险因素简介和住院治疗结果

IF 0.2 Q4 CARDIAC & CARDIOVASCULAR SYSTEMS
Reema Qayoom, Aatkah Naseer, Saba Aijaz, Bashir Hanif
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引用次数: 0

摘要

目的:在巴基斯坦,急性心肌梗死的心血管风险因素正在增加。本研究的目的是比较年轻和年长(分别为 45 岁以下和 45 岁以上)STEMI 患者的传统心血管疾病危险因素、住院死亡率和出院时的主要不良心脏事件。 研究方法:这项回顾性队列研究针对 2013 年 6 月至 2018 年 6 月期间在一家仅有心脏科的三级医疗机构就诊的 STEMI 连续患者。该机构的登记系统与美国 NCDR 一致,并隶属于 NCDR。到院时心脏骤停或心源性休克的患者被排除在外。MACE定义为PCI术后心脏骤停或心源性休克、心力衰竭、大出血或住院死亡。采用逐步前向逻辑回归法建立模型。 结果研究期间共收治了 5343 名 STEMI 患者,在排除了 1642 名患者的数据后进行了分析。在年轻患者中,男性、吸烟和有早发冠状动脉疾病家族史的频率明显更高(所有 p 值均小于 0.001)。而在年龄较大的 STEMI 患者中,心力衰竭、高血压、既往心肌梗死、糖尿病、肌酐清除率异常(<90 mL/min/1.73 m²)、多支血管冠状动脉疾病、Killip 分级较高和体重指数较高者的发病率更高(所有 P 值均<0.001)。在年轻患者中,Killip分级晚期和股动脉入路部位(所有P值均<0.001)、糖尿病(P=0.03)、肌酐清除率异常(P=0.04)和左室射血分数低于40%(P=0.男性(P=0.04)、糖尿病(P=0.001)、股动脉入路部位(P=0.001)和左心室射血分数小于 40% 是更重要的 MACE 预测因素(均 P<0.001)。 结论在对糖尿病、肌酐清除率异常(<90 mL/min/1.73 m²)、多血管冠状动脉疾病、Killip分级晚期等因素进行调整后,年轻与老年STEMI患者的住院死亡率和MACE无明显差异。吸烟是 STEMI 年轻患者的主要可改变风险因素。令人惊讶的是,女性和有早发性冠状动脉疾病家族史的人具有保护作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Risk Factor Profile and Hospital Outcomes in Patients ≤ 45 Years vs. >45 Years of Age Presenting with Acute ST-Segment Elevation Myocardial Infarction
Objectives: In Pakistan, cardiovascular risk factors for acute myocardial infarction are increasing. There are few studies available on atherosclerotic risk factors in young patients and its outcome The purpose of this study was to compare pattern of traditional CVD risk factors, hospital mortality and major adverse cardiac events at discharge in young versus old patients (≤45years and above 45 years age respectively) admitted with STEMI and undergoing primary PCI. Methodology: This retrospective cohort study was conducted on consecutive patients presenting with STEMI between June 2013 and June 2018 in a single centre cardiac only tertiary care setup. Institute’s registry is fashioned along and is affiliated with US NCDR. Patients with cardiac arrest or cardiogenic shock at arrival were excluded. MACE was defined as post PCI cardiac arrest or cardiogenic shock, heart failure, major bleed or hospital death. Models were built using stepwise forward logistic regression method. Results: Total of 5343 patients were admitted with STEMI during study period, after exclusion data of 1642 patients were analyzed. Among young patients, the frequency of the male gender, any tobacco use and family history of premature coronary artery disease were significantly higher (all p values < 0.001). While in older STEMI patients frequency of heart failure, hypertension, prior myocardial infarction, diabetes mellitus ,abnormal creatinine clearance (<90 mL/min/1.73 m²) , multi-vessel coronary disease, advanced Killip class and higher body mass index was more prevalent (all P<0.001). Among young patients advanced Killip class and femoral access site(all P values <0.001), diabetes mellitus (p=0.03), abnormal creatinine clearance(p=0.04),and left ventricular ejection fraction less than 40%(p=0.01), were more significant in-hospital mortality predictor whereas advanced Killip class, Left ventricular ejection fraction less than 40% male gender(p=0.04), diabetes mellitus(p=0.001),femoral access site(p=0.001), and Left ventricular ejection fraction less than 40% were more significant MACE predictors (all P<0.001). Conclusion: There were no significant difference in hospital mortality and MACE among young versus old STEMI patients when adjusted for diabetes mellitus, abnormal creatinine clearance (<90 mL/min/1.73 m²), multi-vessel coronary disease, advanced Killip class. Tobacco use is the main modifiable risk factors for young patients with STEMI. Surprisingly, being a woman and having a positive family history with premature coronary artery disease were protective.
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来源期刊
Pakistan Heart Journal
Pakistan Heart Journal CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
0.20
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0.00%
发文量
64
审稿时长
6 weeks
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