目的：评价年轻人吸烟方式对急性心肌梗死（AMI）临床特征的影响。方法选择2000-06—2013-06入院2周内行冠状动脉造影的年轻AMI患者112例（观察组），年龄≤45岁；连续选取2011-01—2012-11收治的50～70岁AMI患者112例作为对照组。记录患者心血管危险因素（吸烟史、高胆固醇血症、高血压、糖尿病和心血管家族史）和临床特征（心绞痛史、射血分数、住院病死率以及冠状动脉造影结果）并进行分析。结果观察组患者有吸烟史者高达84.8%，明显高于对照组患者（P＜0.01），而对照组最大的危险因素是高血压（P＜0.01）；两组吸烟指数差异无统计学意义（P＞0.05），但观察组每天吸烟量明显大于对照组（P＜0.01）。观察组胸痛＜12h比例高于对照组（均P＜0.01）。观察组累计冠状动脉狭窄积分较对照组低（P＜0.05）；观察组旋支为罪犯血管的发生率较对照组低（P＜0.01），1支血管病变比例较对照组高（P＜0.01），3支血管病变比例较对照组低（P＜0.01）。结论年轻人AMI临床心绞痛病史短，冠状动脉硬化程度轻,病变血管多数以单支血管病变为主，以旋支为罪犯血管极少见。而年轻人长期大量的吸烟方式是影响其AMI临床特征的最主要危险因素。%Objective To evaluate the effects of smoking patterns on clinical features in young patients with acute my-ocardial infarction. Methods From June 2000 to June 2013, 112 consecutive patients≤45 years of age with a diagnosis of AMI, who were performed coronary angiography within 2 weeks after the onset of AMI, were assigned to the observation group. We selected 112 consecutive patients aged 50~70 years old during January 2011 to November 2013 as the control group. The pa-tient's cardiovascular risk factors (ie, smoking, hypercholesterolemia, hypertension, diabetes mel itus, and family history) and clin-ical features (ie, history of angina pectoris, ejection fraction, hospital mortality and coronary angiography images) were recorded and analysed. Results The percent of smoking in observation group were higher than in control group (P<0.01). Smoking index of two groups was similar, but the amount of daily smoking in observation group was higher than in control group (P<0.01). The history of angina pectoris(<12hours) in observation group were shorter than in control group(al P<0.01). The accumulated coro-nary stenosis scores in observation group was lower than in control group (P<0.05). The incidence of left circumflex coronary artery as a culprit artery in observation group was lower than in control group (P<0.01).The incidence of singe vessel disease in observation group was higher than in control group (P<0.01).The incidence of triple vessel diseases in observation group was lower than in control group (P<0.01). Conclusion In young patients, The clinical angina pectoris history is short and the coronary arteriosclerosis degree is light. Young patients had a higher frequency of singe vessel disease. There is rare in left circumflex coronary artery as culprit artery in young patients.The patterns of long- term heavy smoking is the most important impact factor on clinical features among young patients with AMI.
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