探討台灣年輕女性發生第一型及第二型心肌梗塞之前驅症狀、疾病表徵及預後：單一醫學中心回溯式世代研究

Abstract

研究背景與目的：急性心肌梗塞（acute myocardial infarction, AMI）長期被視為男性盛行的心血管疾病，但近年女性AMI患者逐漸受到重視，尤以年輕女性因症狀表現不典型、疾病機轉多樣而具診斷挑戰性。本研究旨在探討台灣年輕女性AMI患者的前驅症狀、急性期臨床表徵與一年內預後情形，以提供臨床診斷與照護之參考。 研究方法：本研究為回溯式世代研究，納入2010年1月至2021年12月、10年間於臺大醫院、出院診斷為AMI且年齡介於18至55歲之女性患者，最終分析樣本數為152人。資料來源為電子病歷系統，蒐集患者之基本人口資料、心血管危險因子、前驅症狀與急性期臨床表徵、心導管檢查與實驗室數據，以及一年內再住院與死亡等預後指標，進行敘述性統計分析。 研究結果與討論：臺大醫院10年間年輕女性AMI患者平均年齡為47歲，具有高血壓為49.3%，（n=75）、糖尿病40.1%（n=61）或高脂血症40.1%（n=61）等傳統危險因子；僅19.7%（n=30）的患者病歷中記載有明確前驅症狀，以胸悶（n=23，76.7%）、呼吸困難（n=12，40.0%）與消化不適（n=6，20.0%）為主；急性發作時最常見症狀為冒冷汗（n=60，39.4%）、胸悶（n=58，38.9%）與胸痛（n=56，36.8%）。進一步分析心導管資料顯示，無明顯血管狹窄之患者（Myocardial infarction with non-obstructive coronary arteries, MINOCA）佔全體9.2%（n=12），其中僅1人（7.1%）有前驅症狀，比例明顯低於整體平均，提示該群病患在臨床辨識上更具困難度。儘管實驗室檢驗中lipid profile（如LDL、TG、HDL）與 HbA1C的中位數皆落於正常範圍，然人口學資料顯示約四成患者被診斷為高脂血症與糖尿病，可能與患者已接受藥物治療有關，導致檢驗值受控，未能完全反映潛在代謝異常；再者，本研究族群的平均體重指數偏高（BMI=25.2 kg/m2），亦顯示其潛藏代謝症候群風險，需於臨床評估中審慎考量。 在預後方面，出院一年內因AMI相關症狀再住院者佔11.2%（n=17），全因死亡率為9.8%（n=15）以住院期間死亡為主（13人，86.7%），出院後一年內再死亡者則為2人（13.3%），反映該族群即使在接受初步治療後，仍具相當比例的再入院與死亡風險，顯示後續照護與危險因子管理的重要性。 結論與臨床意涵：台灣年輕女性AMI患者以典型症狀為主要表現，非典型症狀雖有出現但比例較低，心導管結果亦顯示大多數為狹窄性病變，惟仍有部分MINOCA患者，顯示病因具異質性；全年死亡率達9.8%，相較國際報告偏高，整體而言，顯示即便是年輕女性，臨床照護上仍需關注其多樣表現與潛在風險，以利早期辨識與介入。

Background and Objective:Acute myocardial infarction (AMI) has long been considered a male-dominant cardiovascular disease. In recent years, however, growing attention has been directed toward female AMI patients, especially younger women, due to their atypical symptom presentations and diverse underlying mechanisms, which pose diagnostic challenges. This study aimed to explore the prodromal symptoms, acute clinical manifestations, and one-year outcomes of young female AMI patients in Taiwan, providing evidence to support clinical diagnosis and care. Methods:This retrospective cohort study included female patients aged 18 to 55 years who were discharged with a diagnosis of AMI from a medical center in northern Taiwan between January 2010 and December 2021. A total of 152 patients were analyzed. Data were extracted from electronic medical records, including demographics, cardiovascular risk factors, prodromal and acute symptoms, coronary angiographic and laboratory findings, and one-year outcomes (readmission and mortality). Descriptive statistical analysis was performed. Results and Discussion:The mean age of participants was 47 years. A high proportion had traditional cardiovascular risk factors, including hypertension (n=75, 49.3%), diabetes mellitus (n=61, 40.1%), and hyperlipidemia (n=61, 40.1%). Only 19.7% (n=30) of patients had documented prodromal symptoms, most commonly chest tightness (n=23, 76.7%), dyspnea (n=12, 40.0%), and gastrointestinal discomfort (n=6, 20.0%). The most frequent acute symptoms were cold sweating (n=60, 39.4%), chest tightness (n=58, 38.9%), and chest pain (n=56, 36.8%). Among those who underwent coronary angiography, 9.2% (n=12) were diagnosed with myocardial infarction with non-obstructive coronary arteries (MINOCA). Of whom only one (7.1%) had prodromal symptoms—significantly lower than the overall rate—highlighting the diagnostic challenge of this subgroup. Although the median values of lipid profiles (LDL, TG, HDL) and HbA1C were within normal ranges, approximately 40% of patients were diagnosed with diabetes or hyperlipidemia, likely due to pharmacological control masking underlying metabolic disorders. The average BMI was 25.2 kg/m2, indicating a potential risk of metabolic syndrome requiring careful clinical evaluation. Regarding prognosis, 11.2% (n=17) of patients were readmitted within one year due to AMI-related symptoms. The all-cause one-year mortality rate was 9.8% (n=15), with most deaths occurring during the index hospitalization (13 cases, 86.7%), and 2 additional deaths occurring after discharge. These findings suggest that even after initial treatment, this population remains at considerable risk for adverse outcomes, emphasizing the importance of long-term care and risk factor management. Conclusion and Clinical Implications:Young female AMI patients in Taiwan primarily presented with typical ischemic symptoms, while atypical symptoms were observed in a smaller proportion. Coronary angiographic results revealed that most cases involved obstructive lesions, although some MINOCA cases were also present, indicating etiological heterogeneity. The annual mortality rate reached 9.8%, higher than that reported in international data. These results suggest that, even among young women, clinical care should remain vigilant to diverse presentations and underlying risks to enable timely recognition and intervention.