年轻患者的心肌梗死。一切都那么明显吗?

M. Zykov, O. Barbarash
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摘要

这篇综述专门分析了有关青少年心肌梗死的病程特点、诊断和治疗的文献资料。尽管青少年心肌梗死问题与我们息息相关,但在目前的临床指南中,并没有专门针对此类患者的管理和检查方法。我们在以下数据库中进行了文献检索:PubMed、Google Scholar、Web of Science(1990 年至 2023 年),以 "心肌梗死与年轻"、"动脉粥样硬化与年轻"、"动脉粥样硬化栓塞与年轻 "为关键词搜索所有研究。此外,还对心脏病学、血液学和血管病学领域主要专业学会的所有现有临床建议进行了分析。鉴于该主题的特殊性、广泛性以及既定任务--拓展医生的临床思维,所提交的综述并不系统。不可否认,心肌梗死的一级预防更为有效。鉴于每年年轻心肌梗死患者人数的增加,有必要为年轻患者的风险分层创建一个特殊工具,因为临床指南中没有这样的工具。尽管非致癌因素对年轻患者心肌梗死的发生有较大影响,但动脉粥样硬化仍是心肌梗死发生的主要原因。这篇评论的作者证实了一个事实,即目前还没有专门制定的算法来管理年轻心肌梗死患者,这些算法基于对一些传统和非传统风险因素的识别以及强化康复措施。目前,我们研究所计划对年轻心肌梗死患者进行为期七年的专项研究,其目的和目标就是要确定所有这些立场。
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Myocardial infarction in young patients. Is everything so obvious?
The review is devoted to the analysis of literature data on the features of the course, diagnosis and treatment of myocardial infarction at a young age. Despite the relevance of the problem of myocardial infarction in young people, there is no specific approach to the management and examination of such patients in current clinical guidelines. Literature search was carried out in the following databases: PubMed, Google Scholar, Web of Science from 1990 to 2023 for all studies with the keywords “myocardial infarction and young age”, “atherosclerosis and young age”, “atherothrombosis and young age”. An analysis of all available clinical recommendations of leading specialized societies in the field of cardiology, hematology, and angiology was also carried out. The presented review is not systematic view of the specifics of the subject, its breadth, as well as the task set – to expand the clinical thinking of the doctor. It is undeniable that primary prevention of myocardial infarction is more effective. Given the annual increase in the number of myocardial infarctions at a young age, it is necessary to create a special tool for risk stratification in young patients, since there is no such tool in the clinical guidelines. Despite the greater contribution of non-atherogenic causes to the development of myocardial infarction in young patients, atherosclerosis is still the main cause of its development. The authors of the review confirm the fact that there is currently no specially developed algorithm for managing patients with myocardial infarction at a young age, based on the identification of a number of traditional and non-traditional risk factors, on enhanced rehabilitation measures. All these positions are currently formulated in the aims and objectives of a special sevenyear study of myocardial infarction in young patients planned at our institute.
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