摘要
目的 探讨不同年龄急性冠脉综合征患者冠状动脉病变程度、冠状动脉特点及近期预后.方法 选取2018年 1月到2023年6月汉中市中心医院收治的128例急性冠脉综合征患者进行回顾性分析,依照患者年龄将＜40岁的分为低龄组(n=25),40～60岁的分为中龄组(n=50),＞60岁的分为高龄组(n=53).所有患者均实施冠状动脉旁路移植术或经皮冠状动脉介入治疗.比较不同年龄患者临床基本特征(性别、体重指数、脑血管疾病史、陈旧心肌梗死史、冠心病家族史及合并基础疾病情况)、基础实验室指标[收缩压、舒张压、低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、总胆固醇、甘油三酯、空腹血糖、肌酐及血红蛋白]、冠状动脉病变程度、冠状动脉特点及近期预后情况.结果 不同年龄急性冠脉综合征患者的性别、陈旧心肌梗死史、冠心病家族史、合并糖尿病情况比较,差异均无统计学意义(P＞0.05);不同年龄患者体重指数、脑血管疾病史、合并高血压及高脂血症情况比较,差异均有统计学意义(P＜0.05).不同年龄急性冠脉综合征患者收缩压、舒张压、LDL-C、HDL-C、总胆固醇、空腹血糖、肌酐比较,差异均无统计学意义(P＞0.05),高龄组甘油三酯水平均高于低龄组、中龄组,血红蛋白水平均低于低龄组、中龄组,差异均有统计学意义(P＜0.05).高龄组Gensini评分、GRACE评分均明显高于低龄组、中龄组,差异均有统计学意义(P＜0.05).不同年龄急性冠脉综合征患者病变类型比较,差异无统计学意义(P＞0.05),中龄组与高龄组的病变支数明显高于低龄组,高龄组的钙化斑块比例均明显低于低龄组、中龄组,非钙化斑块比例均明显高于低龄组、中龄组,差异均有统计学意义(P＜0.05).高龄组总主要心血管不良事件发生率为24.53％,均明显高于低龄组(4.00％)和中龄组(12.00％),差异均有统计学意义(P＜0.05).结论 不同年龄急性冠脉综合征患者临床基础情况存在一定差异,且高龄患者多以高血压、高血脂症为主,体重指数也存在一定差异.高龄患者冠脉病变程度严重,狭窄程度和疾病危险程度显著高于年龄较低的患者.高龄患者冠脉病变支数与肺钙化斑块情况居多,且预后情况相比年龄较低的患者预后较差.
Abstract
Objective To explore the extent of coronary artery lesions,coronary artery characteristics and recent prognosis in patients with acute coronary syndrome of different ages.Method A retrospective analysis was conducted on 128 patients with acute coronary syndrome admitted to Hanzhong Central Hospital from January 2018 to June 2023.Patients under 40 years old were divided into the younger group(n=25),those between 40 and 60 years old were divided into the middle age group(n=50),and those over 60 years old were divided into the older group(n=53).All patients underwent coronary artery bypass grafting or percutaneous coronary intervention.The clinical basic characteristics(gender,body mass index,history of cerebrovascular disease,history of old myocardial infarction,family history of coronary heart disease,and comorbidities with underlying diseases),basic laboratory indicators[systolic blood pressure,diastolic blood pressure,low-density lipoprotein cholesterol(LDL-C),high-density lipoprotein cholesterol(HDL-C),total cholesterol,triglycerides,fasting blood glucose,creatinine,and hemoglobin],de-gree of coronary artery disease,coronary artery characteristics,and recent prognosis of patients of different ages were compared.Results There were no statistically significant differences in sex,old myocardial infarction history,family history of coronary heart disease,and diabetes among patients with acute coronary syndrome of different ages(P＞0.05),there were statistically significant differences in body mass index,cerebrovas-cular disease history,hypertension and hyperlipidemia among patients of different ages(P＜0.05).There were no statistically significant differ-ences in systolic blood pressure,diastolic blood pressure,LDL-C,HDL-C,total cholesterol,fasting blood glucose,and creatinine among pa-tients with acute coronary syndrome of different ages(P＞0.05),the triglyceride levels in the elderly group were higher than those in the young and middle-aged groups,and the hemoglobin levels were lower than those in the young and middle-aged groups,the differences were statistical-ly significant(P＜0.05).The Gensini score,GRACE scores in the elderly group were significantly higher than those of the young and middle-aged groups,and the differences were statistically significant(P＜0.05).There was no statistically significant difference in the types of lesions among patients with acute coronary syndrome of different ages(P＞0.05);the number of lesions in the middle-aged and elderly groups was sig-nificantly higher than that in the younger group,and the proportion of calcified plaques in the elderly group was significantly lower than that in the younger and middle-aged groups,the proportion of non-calcified plaques was significantly higher than that in the younger and middle-aged groups,and the differences were statistically significant(P＜0.05).The total incidence of major adverse cardiovascular events in the elderly group was 24.53％,which was significantly higher than those in the younger group(4.00％)and the middle-aged group(12.00％),the differences were statistically significant(P＜0.05).Conclusion There are certain differences in clinical conditions among patients with acute coronary syndrome of different ages,and older patients are mainly characterized by hypertension and hyperlipidemia,and there are also certain differences in body mass index.The degree of coronary artery disease is severe in elderly patients,and the degree of stenosis and disease risk is significantly higher than that in younger patients;The number of coronary artery lesions and pulmonary calcification plaques are more common in elderly patients,and the prognosis is poorer compared to younger patients.
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