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目的:探讨不同年龄段急性心肌梗死患者冠状动脉病变特征。方法:回顾性分析597例急性心肌梗死患者急诊冠状动脉造影结果。根据年龄分为3组:①组1,年龄<60岁,114例;②组2,年龄60～75岁,279例;③组3,年龄≥75岁,204例。应用目测法和冠状动脉病变严重度积分法分析冠状动脉造影结果。结果:①3组冠状动脉前降支(LAD)、回旋支(LCX)、右冠状动脉(RCA)3支血管发生病变的概率相似(P>0.05),但≥75岁组左主干(LM)受累的概率显著高于其余2组,P<0.01;冠状动脉病变严重程度积分无差异,分别为7.58±2.71,7.66±2.98,8.72±3.30,P>0.05;而冠状动脉病变支数随年龄增加而增加,分别为1.89±0.86,2.00±0.83,2.32±0.92,且各组间差异有统计学意义(P<0.05)。②各年龄组梗死相关动脉在LM、LAD、LCX和RCA的分布差异无统计学意义(均P>0.05)。年龄<60岁组、60～74岁组和≥75岁组梗死相关动脉“罪犯”病变狭窄程度差异有统计学意义(均P<0.01):临界病变(50%～75%狭窄)在各组中分布比率分别为2.6%、9.7%和2.9%;重度狭窄(76%～95%狭窄)的比率随年龄增加而增加,分别为18.4%、36.5%和45.6%;次全闭塞和完全闭塞病变的比率随年龄增加而减少,分别为79%、53.8%、51.5%。低危“罪犯”病变比率在年龄<60岁组、60～74岁组和≥75岁组中分别为53%、40%和35%,P<0.05;中危“罪犯”病变比例各年龄组差异没有显著性(P>0.05);高危“罪犯”病变比率组2和组3差异无统计学意义(P>0.05),其余各组差异有有统计学意义(P<0.05)。各组即刻手术成功率分别为97.3%、96.8%和97.1%,差异无统计学意义(P>0.05)。结论:不同年龄急性心肌梗死患者冠状动脉病变有不同的特点。随着年龄的增长冠状动脉病变更加复杂,但并不影响罪犯冠状动脉急诊手术即刻成功率。
Objective: To investigate the characteristics of coronary lesions in patients of different ages with acute myocardial infarction. Methods: A retrospective analysis of 597 cases of acute myocardial infarction patients with coronary angiography results. According to the age group is divided into three groups: ① group 1, age <60 years, 114 cases; ② group 2, aged 60 to 75 years, 279 cases; ③ group 3, age ≥75 years, 204 cases. The results of coronary angiography were analyzed by visual method and coronary angiography. Results: ①The incidences of 3 lesions of 3 vessels in LAD, LCX and RCA of 3 groups were similar (P> 0.05), but left main (LM) Were significantly higher than the other two groups (P <0.01). There was no difference in the severity of coronary artery disease between the two groups (7.58 ± 2.71, 7.66 ± 2.98, 8.72 ± 3.30, P> 0.05) (1.89 ± 0.86, 2.00 ± 0.83, 2.32 ± 0.92, respectively), and the differences among the groups were statistically significant (P <0.05). ② There was no significant difference in distribution of LM, LAD, LCX and RCA among all age groups (P> 0.05). There were significant differences in the degree of stenosis between infarct-related artery and “criminal” in patients <60 years old, 60-74 years old and ≥75 years old (all P <0.01): The critical lesion (50% -75% stenosis) The ratios of severe stenosis (76% -95% stenosis) increased with age (18.4%, 36.5% and 45.6%, respectively); subtotal occlusion and complete Occlusion lesion rate decreased with age, respectively, 79%, 53.8%, 51.5%. The risk of “low-risk” “criminal” lesions was 53%, 40%, and 35% in the age group <60 years, 60-74 years and ≥75 years, respectively, P <0.05; (P> 0.05). There was no significant difference between high risk group and group 3 in the rate of “criminal” (P> 0.05), and the difference between the other groups was statistically significant (P < 0.05). The success rate of immediate operation in each group was 97.3%, 96.8% and 97.1%, respectively, with no significant difference (P> 0.05). Conclusion: There are different characteristics of coronary artery lesions in patients with acute myocardial infarction at different ages. Coronary artery disease is more complicated with age, but does not affect the success rate of immediate emergency surgery of criminals.