不同性别急性ST段抬高型心肌梗死患者临床特征及住院期间预后分析

目的总结不同性别急性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)患者的临床特征、治疗方案及住院期间转归。方法回顾性分析1 686例(男1 224例,女462例)STEMI患者的临床资料。结果女性STEMI患者年龄70.43(63.69,76.39)岁]较男性61.21(50.90,70.22)岁]大,吸烟比率(3.03%)较男性(55.07%)低,前壁心肌梗死比率(60.17%)、合并心律失常比率(23.16%)、心率>100次/min比率(12.99%)及合并高血压、高胆固醇血症、糖尿病比率(56.71%、12.34%、22.08%)较男性(55.07%、17.08%、8.91%、43.06%、6.78%、13.81%)高(P<0.05)。女性患者保守治疗比率(57.36%)较男性(37.75%)高,溶栓治疗、择期行经皮冠状动脉介入术、发病12 h内再灌注治疗比率(20.35%、17.10%、27.27%)较男性(30.23%、24.92%、43.14%)低(P<0.05),入院至球囊扩张时间、入院至溶栓药物注射时间、发病至首次医疗接触时间等与男性比较差异无统计学意义(P>0.05)。女性患者住院期间病死率(6.28%)及不良心脑血管事件发生率(13.85%)均高于男性(2.37%、8.25%)(P<0.05)。广义线性混合模型调整年龄与中心效应后,女性为STEMI患者住院期间死亡(OR=2.32,95%CI:1.30~4.14,P=0.004)、发生不良心脑血管事件的独立危险因素(OR=1.76,95%CI:1.25~2.47,P=0.024)。结论与男性患者比较,女性STEMI患者住院病死率及不良心脑血管事件发生率较高,可能与年龄较大、合并较多的心血管疾病高危因素、多采取保守治疗有关。

Clinical features and in-hospital prognosis of female acute ST-segment elevation myocardial infarction

Objective To investigate the clinical features, treatment and in-hospital prognosis of male and female patients with acute ST-segment elevation myocardial infarction(STEMI). Methods The clinical data of 1 686 STEMI patients(1 224 males, 462 females) were retrospectively analyzed. Results The female patients were older than male patients(70.43(63.69, 76.39) vs. 61.21(50.90, 70.22), had less smokers than male patients(3.03% vs. 55.07%), larger percentages of anterior myocardial infarction(60.17% vs. 55.07%), arrhythmia(23.16% vs. 17.08%), heart rate over 100 beats/min(12.99% vs. 8.91%), hypertension(56.71% vs. 43.06%), hypercholesterolemia(12.34% vs. 6.78%), and diabetes(22.08% vs. 13.81%)(P<0.05). More female patients received conservative treatment than male patients(57.36% vs. 37.75%)(P<0.05), and less female patients received thrombolytic therapy(20.35% vs. 30.23%), selective percutaneous coronary artery intervention(17.10% vs. 24.92%) and reperfusion therapy within 12 h(27.27% vs. 43.14%) than male patients(P<0.05). The time of door to balloon, door to needle and the time of onset to first medical contact showed no significant differences between female and male patients(P>0.05). The in-hospital mortality and the incidence of main adverse cardiovascular and cerebrovascular events were higher in female patients(6.28%,13.85%)than those in male patients(2.37%,8.25%)(P<0.05).Female was the independent risk factor for in-hospital mortality(OR=2.32,95%CI:1.30-4.14,P=0.004)and main adverse cardiovascular and cerebrovascular events(OR=1.76,95%CI:1.25-2.47,P=0.024)after age and central effect adjusted using generalized linear mixed model.Conclusion The in-hospital mortality and incidence of main adverse cardiovascular and cerebrovascular events are higher in female patients,which is probably correlated with old age,more risk factors for cardiovascular diseases and high percentage of conservative treatment.