Analysis Of Clinical And Coronary Angiographic Characteristics And 1-year Prognosis Of Young Male Patients With STEMI And NSTEMI

Objective:Analyze the clinical and coronary angiographic characteristics and 1-year incidence of heart failure,recurrent myocardial infarction and angina pectoris of young male patients with first acute myocardial infarction,to provide evidence for the primary and secondary prevention,decrease morbidity and improve the prognosis.Method:Through the electronic medical record,141 patients younger than 40 years old who underwent coronary angiography in the Second Department of the First Hospital of Jilin University due to acute myocardial infarction（AMI）from January 1,2013 to February 28,2021 were retrospectively collected.106 cases were finally included through the inclusion and exclusion criteria.According to the ST segment elevation or not,they were divided into STEMI（72 cases）and NSTENI（24 cases）,then analyzing clinical and coronary angiographic characteristics.All patients were followed up 1year to observe 1-year survival rate and incidence of heart failure,recurrent myocardial infarction,angina pectoris and composite endpoint events.SPSS 26 was applied for statistical analysis.The Kolmogorov-Smirnov method was used to test the normality of the measurement data.The continuous variables conforming to normal distribution were used independent sample t test and expressed as mean ±standard deviation.The continuous variables did not conform to the normal distribution were analyzed by Mann Whitney test and represented by median（interquartile range）M（Q25,Q 75）.Pearson chi-square test or Fisher’s exact probability method was used to analyze classified variables,expressed as frequency and percentage.Firstly,single factor analysis was performed on baseline data,parameters of serological examination and echocardiography,then multivariate binary logistic regression analysis was used for the variables with p<0.05 in the univariate analysis and odds ratio（OR）and 95%confidence interval（CI）were calculated.For the selected continuous risk factors,draw the receiver operating characteristic（ROC）curve,to calculate the area under the curve（AUC）,sensitivity,specificity and Youden index.The variable value corresponding to the maximum Youden index is the best cutoff value.The KaplanMeier survival curve was used for comparison 1-year incidence of heart failure,recurrent myocardial infarction,angina pectoris and composite endpoint events between two groups.p<0.05 indicated that the difference was statistically significant.Results:1.The average age of 106 patients was 35.47 ± 4.44 years old.There were 74 cases of STEMI（69.8%）and 32 cases of NSTEMI（30.2%）,with the median age of 37.The most common risk factor of young male patients with AMI was smoking,followed by hypertension.Smoking was more popular in STEMI while hypertension was in NSTEMI（p<0.05）.2.The clinical symptoms of young patients with AMI included chest pain,sweating,radiating pain of jaw,upper limb and/or back,gastrointestinal symptoms,chest distress or feeling of being close to death,unconsciousness,dizziness and so on.There were 98（92.45%）cases had chest pain,59（55.7%）cases presented sweating.Chest pain was the most common clinical symptom of STEMI and NSTEMI for young male patients with AMI,and there was no significant difference between two groups（p>0.05）.The incidence of sweating in STEMI was higher than that in NSTEMI（p < 0.05）.3.Single factor analysis showed that hypertension,smoking,total cholesterol,low density lipoprotein cholesterol,aspartate aminotransferase,alanine aminotransferase,total bilirubin,serum uric acid,fasting blood glucose,white blood count,absolute value of neutrophils and monocytes,peak value of cardiac troponin T were higher in STEMI than NSTEMI,and initial value of cardiac troponin T and left ventricular ejection fraction were lower（p<0.05）.4.Multivariate logistics regression analysis showed that compared with NSTEMI,the independent risk factors associated with STEMI were elevated aspartate aminotransferase（OR=1.019,95%CI:1.000-1.038）,hyperuricemia（OR=1.012,95%CI:1.002-1.021）and elevated peak value of cardiac troponin T（OR=2.246,95%CI:1.008-5.005）（p < 0.05）.5.After plotting receiver operating curve（ROC）of aspartate aminotransferase,uric acid and peak value of cardiac troponin T to distinguish STEMI and NSTEMI,it can be seen that the AUC value of aspartate aminotransferase is 0.805,and when the best cut-off value is 104,the sensitivity is 74.3 %,the specificity is 78.1%;the AUC value of uric acid is 0.659,when the best cut-off value is180.5,the sensitivity is 98.6%,the specificity is 34.4%;the AUC value of peak value of cardiac troponin T is 0.797,When the best cut-off value is 1.89,the sensitivity is 67.6% and the specificity is84.4%.Aspartate aminotransferase and peak value of cardiac troponin T are more effective than uric acid in identifying STEMI and NSTEMI,aspartate aminotransferase has higher sensitivity while peak value of cardiac troponin T has higher specificity.6.It was seen that coronary artery disease presented in 100（94.3%）patients,while6（5.7%）patients showed normal coronary angiogram.Regarding disease pattern,single vessel disease was the most common,seen in 70（66%）patients,double and triple vessel disease was in 20（18.9%）and 10（9.4%）patients respectively.LAD was the commonnest disease vessel in young patients.A subgroup analysis of 70 single vessel disease patients showed that LAD was culprit vessel in 39（55.7%）,RCA in19（27.1%）,LCX in 12（17.1%）.Among 20 patients with two vessel disease,10（50%）had a combination of LAD and RCA,8（40%）had LAD and LCX,while 2（10%）had LCX and RCA.Among the 106 patients,the LAD was involved in 150（39.5%）either singly or in combination with other vessels,RCA in 133（35%）,LCX in 94（24.7%）,while LM in 03（0.8%）.Regarding lesion characteristics,the commonnest site for occurrence of lesion was Proximal segment in LAD and LCX,and mid segment in RCA.Tight lesions were the most common in LAD,followed by moderate stenosis,LCX and RCA were mainly mild and severe stenosis.7.The time from onset to PCI or PTCA in STEMI was significantly shorter than NSTEMI（p<0.05）.Compared with NSTEMI,STEMI had higher proportion of coronary occlusion,thrombus aspiration and TIMI blood flow grade 0-2（p<0.05）,and lower proportion of severe coronary stenosis（p<0.05）.There was no significant difference between two groups in coronary artery lesion branches,location and cumulative number of coronary lesions,mild and moderate stenosis,collateral circulation and number of implanted stents（P > 0.05）.8.All included patients were followed up 1 year through telephone or outpatient.The 1-year survival rate of young male patients with AMI was 100%.STEMI and NSTEMI had heart failure in 6 cases（8.8%）and 1 case（3.7%）,recurrent myocardial infarction in 5 cases（7.4%）and 1 case（3.7%）,angina pectoris in 14 cases（20.6%）and 10 cases（37%）and composite end point events in 22 cases（32.4%）and 10 cases（37%）respectively,there was no significant difference between the groups（P >0.05）.Then the 1-year incidence of heart failure,recurrent myocardial infarction,angina pectoris and composite end point events between STEMI and NSTEMI was no difference by K-M survival curve analysis（p>0.05）.Conclusions:1.The incidence of STEMI was higher than NSTEMI in young male patients with AMI.2.The most common risk factor of young male patients with AMI was smoking,followed by hypertension.Smoking was more popular in STEMI while hypertension was in NSTEMI.3.Chest pain was the most common clinical symptom of young male patients with AMI,sweating was next.STEMI is more prone to sweat.4.The levels of aspartate aminotransferase,uric acid and peak value of cardiac troponin T in STEMI were higher than those in NSTEMI.5.Coronary artery lesions in young men with AMI were mainly single vessel disease,and LAD was the most common culprit vessel.STEMI preferred early PCI or PTCA than NSTEMI.The proportion of coronary occlusion and thrombus aspiration for STEMI was higher,and TIMI blood flow grade was mostly 0-2.NSTEMI had higher incidence of severe coronary stenosis,and TIMI blood flow grade was mostly3.6.The 1-year survival rate of young male patients with AMI was 100%.The 1-year incidence of composite end events of heart failure,recurrent myocardial infarction and angina pectoris in STEMI and NSTEMI was 32.4% and 37%.