Clinical Characteristics,risk Factors And In-hospital Prognosis Of Young Patients With First Onset Acute Myocardial Infarction

Objective:To explore the clinical characteristics,risk factors and in-hospital prognosis of young patients with first onset acute myocardial infarction(AMI),so as to provide a basis for young patients with AMI to take preventive measures,reduce the incidence rate and improve the prognosis.Method:A total of 175 young patients(19-35 years old,n=175 cases,including 161 males and14 females)who underwent coronary intervention surgery in the Department of Cardiovascular Medicine of our hospital from January 2019 to December 2021 and were first definitely diagnosed as AMI were retrospectively collected through electronic medical records.During the same period,patients in the prime(36-50 years old)and the middle and old(50-78 years old)who underwent coronary intervention surgery in the Department of Cardiovascular Medicine of our hospital and were first definitely diagnosed as AMI were randomly selected as the case control group according to the ratio of youth: prime: middle and old=1:1:1.As well as young healthy people who were hospitalized at the physical examination center of our hospital during the same period,a healthy control group was randomly selected based on the ratio of young AMI patients to young healthy people=1:1.Compare the differences in baseline data and laboratory indicators between the young AMI group and the young healthy control group.Compare the differences in baseline data,laboratory indicators,coronary angiography results,clinical diagnosis,treatment and hospitalization between the young AMI group and the middle-aged and elderly AMI group.At the same time,further analyze the gender differences in the young first-episode AMI group.SPSS25.0 software was used for statistical analysis.The continuous variable data were tested by Kolmogorov-Smirnov method,and the mean ± standard deviation( x±s)indicates that the inter-group comparison is subject to t-test and analysis of variance,and those that do not conform to the normal distribution are represented by the median M(Q25,Q75),and the inter-group comparison is subject to rank sum test;The data of categorical variables were expressed in the number of cases or percentage(%).The comparison between groups was performed by Pearson chi-square test or Fisher’s exact probability method.After single factor analysis,the indicators with statistical differences were adjusted for confounding factors by using the binary logistic regression model,and the multi-factor analysis was carried out.The difference was statistically significant(P<0.05).Result:(1)175 young patients diagnosed as AMI for the first time through coronary intervention were included.Compared with healthy young people,hypertension and diabetes were independent risk factors for young patients with AMI for the first time,while medical insurance and HDL-C were protective factors(P<0.05).(2)Hypercholesterolemia and hyperuricemia/gout have the highest incidence among young patients with AMI,accounting for 54.9% and 45.1% of young patients respectively.Currently smoking has the highest incidence among prime patients with AMI,accounting for52.6% of the prime patients.Rural residents and hypertension have the highest incidence among middle-aged and elderly patients with AMI,accounting for 40.0% and 57.7% of middle-aged and elderly patients respectively.Rural residents,hypertension,and hyperuricemia/gout have statistical differences between young and prime,as well as middle-aged and elderly patients(P<0.05).Hypercholesterolemia only has statistical differences between young and middle-aged and elderly patients(P=0.003).Current smoking only has statistical differences between prime and middle-aged and elderly patients(P =0.020).(3)The young patients with first-episode AMI showed higher levels of WBC,NE #,ALT,uric acid and LDL-C than the prime and middle-aged and elderly patients,and the difference was statistically significant(P<0.05).(4)Only 45.7% of young patients with first-episode AMI visited the hospital within the onset time window.The most common culprit vessel was the LAD(43.4%),followed by RCA involvement(34.9%),and fewer patients developed collateral circulation(13.7%).The above differences were not statistically significant compared with the prime and middle-aged and elderly patients(P>0.05).In young patients,single vessel coronary artery disease was predominant,while in prime and middle-aged and elderly patients,multiple vessel disease was predominant(43.4% vs62.9% vs73.1%,P < 0.001).Stent implantation is the most common method for achieving reperfusion in all three groups of patients,but the stent implantation rate in young patients is lower than that in prime and middle-aged and elderly patients(69.1% vs80.6% vs89.7%,P<0.001).Young patients need less planned secondary PCI treatment(13.7% vs27.4% vs29.7%,P=0.004).(5)In young patients with first episode AMI,chest pain was the main symptom(89.1%),and anterior and inferior wall involvement was common,accounting for 32.6% and 39.4%respectively.STEMI was more common than NSTEMI(73.7% vs 25.1%),with no statistical difference compared with the prime and middle-aged and elderly patients(P>0.05).The KILLIP grade of cardiac function ≥ 2 in young and prime patients with myocardial infarction was less(11.4% vs8.0% vs21.7%,P =0.001).In terms of treatment,most of the patients in the three groups were treated with dual antiplatelet and statin therapy,but young patients received fewer aspirin therapy(90.9% vs 97.7%,P=0.007)and more β-Receptor blockers therapy(75.4%vs58.3%,P=0.002)than middle-aged and elderly patients.The number of prime patients receiving ACEI /ARB /ARNI was more than that of young and middle-aged and elderly patients(53.1% vs66.3% vs46.9%,P =0.001),the number of middle-aged and elderly patients receiving diuretics was more than that of the prime patients(18.3%vs33.1%,P =0.006),and the number of patients receiving antiarrhythmic drugs was more than that of young and prime patients(8.6% vs3.4% vs14.3%,P =0.002).(6)Multivariate logistic regression analysis showed that in young patients with first-time AMI,compared with middle-aged patients,WBC(OR=1.118,95%CI:1.046-1.195),uric acid(OR=1.004,95%CI: 1.001-1.006),and LDL-C(OR=1.275,95%CI:1.002-1.623)were independent risk factors,compared with middle-aged and elderly patients,WBC(OR=1.170,95%CI: 1.050-1.305),uric acid(OR=1.009,95%CI: 1.005-1.012),and TG(OR=1.757,95%CI: 1.188-2.598)were independent risk factors.In prime patients with first-time AMI,compared with middle-aged and elderly patients,uric acid(OR=1.004,95%CI: 1.001-1.007)and TG(OR=1.949,95%CI: 1.444-2.631)were independent risk factors.(7)The ROC curves were drawn for the statistically significant variables in the multifactorial analysis of the three groups of patients: young vs prime,young vs middle-aged and elderly,and prime vs middle-aged and elderly,to explore their ability to identify the first AMI in young,prime,middle-aged and elderly.The results showed that the AUC value of the first AMI in young and prime was 0.724(95% CI: 0.671 ～0.777),the sensitivity was82.46%,and the specificity was 51.79%.The AUC value of the first AMI in young and middle-aged and elderly people was 0.913(95% CI: 0.881 ～ 0.944),the sensitivity was84.83%,and the specificity was 83.23%.The AUC value of the first AMI in the prime and middle-aged and elderly was 0.842(95% CI: 0.799 ～ 0.886),the sensitivity was 84.11%,and the specificity was 70.39%.This model has the strongest sensitivity and specificity for predicting the first AMI in young and middle-aged and elderly people.(8)Among the 175 young patients with first-episode AMI included,3(1.7%)died in hospital,23(13.1%)suffered from heart failure during hospitalization,and 16(9.1%)suffered from new malignant arrhythmia,most of them were tachyarrhythmia(8.0% vs1.1%),and 34(19.4%)had MACE in hospital.Compared with the prime and middle-aged and elderly patients,the above differences were not statistically significant(P>0.05).(9)Among the 175 young patients with first-episode AMI,161 were male(92.0%)and14 were female(8.0%).The median age of the two groups was 32(29,34)years and 34(33,35)years respectively,with no statistically significant difference(P =0.254).The LY #,BNP and QTC of young women were higher than those of young men,while the creatinine,sodium,ALT,albumin,uric acid,TG and LVEDD of young men were higher than those of young women,with statistically significant differences(P<0.05).Compared to young male patients,the incidence of KILLIP ≥ 2 in young women is higher(8.1% vs50.0%,P<0.001),and more likely to receive diuretic treatment(23.0% vs50.0%,P =0.048).The general information,past medical history,coronary angiography,and hospital prognosis of the two groups of young patients did not show significant statistical differences in this study(P>0.05).Conclusions:(1)Dyslipidemia and hyperuricemia /gout are the most common independent risk factors in young patients with first-episode AMI,while medical insurance and high-density lipoprotein cholesterol are the protective factors.(2)Young patients with first-episode AMI are mainly characterized by chest pain,STEMI is more common than NSTEMI,and there are fewer patients with KILLIP grade ≥2.(3)In young patients with first episode AMI,the most common involvement is in the left anterior descending artery,and single coronary artery disease is the main cause,requiring less planned secondary PCI treatment.Postoperative treatment with dual antiplatelet and statin drugs is commonly accepted,and is more commonly acceptedβ-Receptor blocker medication than middle-aged and elderly patients.(4)The incidence of MACE in young patients with first-episode AMI was 19.4%,and the death rate in hospital was 1.7%.In this study,there was no significant difference between prime patients and middle-aged and elderly patients.(5)The majority of young patients with first-episode AMI were male,and there were gender differences in clinical characteristics.Male patients showed higher levels of uric acid and triglyceride,while female patients showed higher levels of BNP.Compared with young men,young women are more likely to have cardiac function KILLIP grade ≥ 2 after myocardial infarction and need more diuretic treatment.