急性心肌梗塞住院死亡率女性高于男性的原因

为了阐明急性心肌梗塞(AMI)住院死亡率女性高于男性的原因,对1987年2月至1991年12月间梗塞后1周内住院、并选入多中心梗塞后试验的510例AMI患者(男355例、女155例)之冠心病监护病房资料进行回顾性分析,分类变量用卡方检验,偏态连续变量     

女性急性心肌梗塞患者溶栓疗效观察

目的　观察女性急性心肌梗塞 (AMI)患者接受静脉溶栓治疗的临床效果。方法　回顾分析 3年内接受静脉溶栓 3 0 2例 (AMI)患者中的 83例女性AMI的临床疗效。结果　 ( 1 ) 83例女性AMI与 2 1 9例男性患者比较 ,溶栓后梗塞相关血管 (IRA)再通率明显为低 ( 57 8%比 73 5% ,P <0 0 1 ) ,尤其3 8例≥ 60岁的老年女性比 92例老年男性明显为低 ( 55 9%比 73 0 % ,P <0 0 2 5)。 ( 2 )经溶栓治疗的男性AMI患者比女性的 5周死亡率 ( 4 1 %比 1 4 5% ,P <0 0 1 )及中度以上心衰率 ( 1 4 2 %比 2 6 5% ,P<0 0 5)明显为低。结论　国人女性AMI患者接受溶栓治疗安全有效 ,但其临床疗效似乎低于男性患者。     

女性ST段抬高型心肌梗死后直接PCI的死亡率或高于男性

<正>为评估性别对STEMI患者直接PCI(PPCI)后死亡率的影响,来自莱特研究生医学教育中心Samir Bipin Pancholy等进行了一项Meta分析,全文于9月29日在线发表在JAMA Intern Med。该研究共纳入了35项研究共68536例STEMI症状出现后12 h内接受PCI的患者,其中男性49981例,女性18555例。主要研究结局为不同性别的住院死亡率和1年全因死亡率。研究发现,在未校正分析中,与男性相比,女性的住     

188例急性心肌梗塞病人的早期治疗与合并症及死亡率的相关性分析

冠心病(CHD)是目前临床上的多发病，急性心肌梗塞(AMI)的发生率亦日趋升高，其首诊医院的早期处理是否得当，直接关系到病情的发展及预后。本研究就近年来我院所接诊的188例AMI病人进行回顾性分析，以探讨AMI病人的早期治疗与合并症及死亡率之间的相互关系。     

女性糖尿病患者的卒中风险高于男性

糖尿病是全球人口死亡和残疾的一个重要病因,同时也是一种强烈的卒中危险因素。不同性别人群之间由糖尿病引起的卒中风险是否存在差异以及到何种程度尚不清楚。澳大利亚悉尼大学乔治全球健康研究所的Peters等进行了一项系统评价和汇总分析,旨在评估糖尿病对不同性别人群卒中风险的相对影响。     

女性急性心肌梗塞的临床特点

121例女性急性心机梗塞(AMI)者与同期入院的347例男性AMI者进行了对比研究。女性组≥56岁者占总数的95.0％,男性组80.1％(P<0.01)。女性组发病从60岁进入高峰,男性组为50岁。以典型胸痛和不典型胸痛发病两组间无显著差异。女性组以心律失常和胃肠道不适为发病疟状明显高于男性组(P<0.05～0.01)。两组的主要并发症及住院死亡率也有程度不同的差别。     

113例急性心肌梗塞住院期间死亡原因分析

回顾性分析113例急性心肌梗塞住院死亡病例，梗塞多累及前壁，死亡时间多在发病一周内，直接死亡原因为：泵衰竭（52.5％）、心脏骤停（36．3％）及心脏破裂（6、2％）。本组因泵衰竭死亡者较多，可能与高龄，大面积梗塞有关。     

女性急性心肌梗塞的特点和近期预后因素分析

对６３９例男性和２４７例女性急性心肌梗塞（ＡＭＩ）住院患者的临床和实验室检查资料进行分析。结果发现：住院期间女性ＡＭＩ患者病死率为２１．８％，男性为１３．７％，两组比较有极显著性差异（Ｐ＜０．００５）。女性组ＡＭＩ患者与男性比较，年龄较大，有高血压病史者较多，前壁梗塞较多，血清肌酸磷酸激酶水平较低，血糖水平较高，心脏破裂者较多。上述因素可能是构成女性ＡＭＩ患者预后较差的原因。此外，多因素逐步回归分析表明，心绞痛史、血尿素氮水平、血清总胆固醇水平和心源性休克是女性ＡＭＩ患者住院死亡的预测因素。     

女性心梗后短期死亡率较高

由于有了雌激素的保护,绝经前女性出现心脏病的风险一般比男性小,绝经后两性的心血管疾病风险就没有很大的差别了。那么男女性心脏病预后有没有差别?近日发表于美国心血管杂志的报道显示,女性心肌梗塞后短期内死亡率比男性要高。荷兰的 Dr.Huiberdina L.Koek 和他的同事研究了1995年因心肌梗塞而住院的     

Ⅱ型糖尿病患者急性心肌梗塞后梗塞延伸的原因探讨

４７例Ⅱ型糖尿病和４７例非糖尿病患者急性心肌梗塞（ＡＭＩ）后梗塞延伸（ＩＭＥＸＴ）的发生情况表明：Ⅱ型糖尿病患者ＩＭＥＸＴ发生率明显高于非糖尿病患者（Ｐ＜０．０５）；而性别之间无显著性差异（Ｐ＞０．０５）。Ⅱ型糖尿病是ＡＭＩ后易发生ＩＭＥＸＴ的高危因素；高血压、低ＨＤＬ－Ｃ和交感兴奋是Ⅱ型糖尿病患者ＩＭＥＸＴ的促发因素；ＩＭＥＸＴ是Ⅱ型糖尿病患者ＡＭＩ后早期死亡率高的主要原因。     

Heparin After Acute Myocardial Infarction

Heparin is commonly, but by no means universally, used after acute myocardial infarction. When used the dose, route of administration, and duration of therapy varies considerably. The role of heparin is reviewed with particular reference to its use in conjunction with other commonly used therapies, such as aspirin and thrombolytic agents. Intravenous heparin after thrombolytic therapy remains untested in patients treated with aspirin. When used, benefit is seen in a narrow aPTT range, and there have been unexpected increases in mortality in patients with the greatest heparin effect. The addition of delayed subcutaneous heparin to aspirin and thrombolytic therapy does not provide a mortality benefit. In patients not treated with thrombolysis, there is no clear evidence that heparin confers significant mortality benefit if patients are treated with aspirin. Heparin therapy may reduce the incidence of intraventricular thrombus after anterior wall infarction, but there is no clear evidence that it reduces the clinically important sequelae of cerebral embolism and stroke. Given concerns about increased hemorrhagic rates with heparin and unknown benefit, it is reasonable to conclude that its role in the management of patients with acute myocardial infarction remains unclear.     

Presentations of Acute Myocardial Infarction in Men and Women

OBJECTIVE: To assess the influence of gender on the likelihood of acute myocardial infarction (AMI) among emergency department (ED) patients with symptoms suggestive of acute cardiac ischemia, and to determine whether any specific presenting signs or symptoms are associated more strongly with AMI in women than in men. DESIGN: Analysis of cohort data from a prospective clinical trial. SETTING: Emergency departments of 10 hospitals of varying sizes and types in the United States. PATIENTS: Patients 30 years of age or older (n = 10,525) who presented to the ED with chest pain or other symptoms suggestive of acute cardiac ischemia. MEASUREMENTS AND MAIN RESULTS: The prevalence of AMI was determined for men and women, and a multivariable logistic regression model predicting AMI was developed to adjust for patients' demographic and clinical characteristics. AMI was almost twice as common in men as in women (10% vs 6%). Controlling for demographics, presenting signs and symptoms, electrocardiogram features, and hospital, male gender was a significant predictor of AMI (odds ratio [OR] 1.7; 95% confidence interval [CI] 1.4, 2.0). The gender effect was eliminated, however, among patients with ST-segment elevations on electrocardiogram (OR 1.1; 95% CI 0.7, 1.7) and among patients with signs of congestive heart failure (CHF) (OR 1.1; 95% CI 0.8, 1.5). Signs of CHF were associated with AMI among women (OR 1.9; 95% CI 1.4, 2.6) but not men (OR 1.0; 95% CI 0.8, 1.3). Among patients who presented to EDs with chest pain or other symptoms suggestive of acute cardiac ischemia, AMI was more likely in men than in women. Among women with ST-segment elevation or signs of CHF, however, AMI likelihood was similar to that in men with these characteristics.     

急性心肌梗死药物治疗研究进展

急性心肌梗死的治疗主要涉及药物和介入两个方面。及时有效的介入治疗能迅速开通阻塞的冠状动脉、挽救濒死心肌,降低急性心肌梗死病人的病死率和病残率。与介入治疗相比,强化的药物治疗方案不仅价格便宜,而且更容易推广实施。现就有关的药物治疗现状及进展作一综述。     

急性心肌梗死经皮冠状动脉介入治疗研究进展

急性心肌梗死的治疗主要涉及药物和介入治疗两个方面。及时有效的经皮冠状动脉介入治疗能迅速开通阻塞的冠状动脉、挽救濒死心肌,降低急性心肌梗死病人的病死率和病残率。现就有关急性心肌梗死的经皮冠状动脉介入治疗研究进展作一综述。     

Effect of Trimetazidine on Late Potentials After Acute Myocardial Infarction

Summary. The purpose of this study was to evaluate the effect of trimetazidine on late potentials in patients with acute myocardial infarction. A total of 60 patients (52 males, mean age 55 ± 2 years, and 8 females, mean age 54 ± 1.8 years) with the diagnosis of acute myocardial infarction were included in this study. The study was designed as a randomized, double-blinded, and placebo-controlled trial. Signal-averaged electrocardiography and echocardiography were performed during the first 2 days of acute myocardial infarction and were repeated between days of 8 and 15 (mean 11). Patients were treated with trimetazidine (n = 30) or placebo (n = 30). In the placebo group, the total filtered QRS duration and low-amplitude terminal signal duration increased (from 102.7 ± 1.8 ms to 113.3 ± 1.8 ms, and from 32.2 ± 0.9 ms to 38.3 ± 1.1 ms; P < 0.001), the root mean square voltage of the terminal 40 ms of the QRS decreased (from 28.6 ± 2.1 µV to 21.4 ± 1.3 µV; P < 0.001), and the incidence of late potentials increased (from 30% to 46%; P < 0.01) significantly. In the trimetazidine group, these measurements were a decrease from 102.9 ± 1.9 ms to 100 ± 2.0 ms (NS), an increase from 31.6 ± 0.9 ms to 32.5 ± 0.9 ms (NS), a decrease 29.3 ± 2.0 µV to 27.3 ± 1.8 µV (P < 0.01), and a decrease from 33% to 30% (NS), respectively. The ejection fraction was 47.1 ± 1.3% to 50.8 ± 1.2% in the placebo group (P = 0.05), and 48.1 ± 1.1% to 53.4 ± 1.2% (P < 0.01) in the trimetazidine group. It is concluded that trimetazidine reduces late potentials after acute myocardial infarction without changing blood pressure and heart rate.     

Acute Myocardial Infarction Mortality Related to Use of Calcium Antagonists Before Admission to Hospital

We investigated whether prior use of calcium antagonists in 80 (16.8%) out of 477 patients (64% males) admitted with acute myocardial infarction (MI) had any impact on in-hospital mortality. Patients using calcium antagonists were slightly older (74 years vs. 72 years, 2P = 0.039) than those not taking them and fewer were male patients. Previous MI, diabetes mellitus, and prior use of aspirin, beta-blockers, and long-acting nitrates were more frequent in patients on calcium antagonists. In contrast, fewer patients on calcium antagonists prior to symptoms received thrombolytic treatment (21.3% vs. 34.8%, 2P = 0.018). The study had an observational exposed/nonexposed design, and we looked for both crude and adjusted effects. Of the 83 patients (17.4%) who died during hospitalization, 18 patients were in the calcium antagonist group (22.5%). The odds ratio (OR) for these patients to die in the hospital was 1.48 and the 95% confidence interval (CI) 0.78–2.78; 2P = 0.19. When adjusting for confounders (gender, age, smoking habit, previous MI, and diabetes mellitus, as well as prior use of aspirin, beta-blockers, long-acting nitrates, and thrombolytic treatment at entry) OR was 1.08 and 95% CI 0.57–2.05; 2P = 0.85. Thus, we found no excess in-hospital mortality in patients with acute MI using calcium antagonists prior to the onset of symptoms.     

中国急性心肌梗死患者住院期间死亡的危险因素分析

目的:探讨当代中国急性心肌梗死(AMI)患者住院期间死亡的危险因素。方法:纳入2013年01月至2014年09月中国急性心肌梗死(CAMI)注册登记研究的AMI患者23417例[其中5795例非ST段抬高型心肌梗死(NSTEMI)患者和17622例ST段抬高型心肌梗死(STEMI)患者]。1504例患者在住院期间死亡,为死亡组,余住院期间生存的21913例患者为生存组。收集患者基线资料、实验室检查、治疗方法、院内结局等临床资料,以住院期间死亡为主要终点构建多因素Logistic回归模型,探讨AMI患者住院期间死亡的独立危险因素。结果:6.42%(1504/23417)的AMI患者在住院期间死亡。与生存组比较,死亡组患者年龄更大,女性患者更多,体重指数更低,合并糖尿病、高血压的比例更高,Killip心功能分级更高,并发症更多,并且更易出现心脏骤停(P均<0.05)。多因素Logistic回归分析结果提示,年龄、性别、体重指数、收缩压、心率、血肌酐水平、白细胞计数、血清钾浓度、血清钠浓度、STEMI、前壁心肌梗死、心脏骤停、Killip心功能分级、高血压、高脂血症及吸烟史是预测患者住院期间死亡的独立危险因素。结论:本研究发现16个当代中国AMI患者住院期间死亡的独立危险因素,有助于临床医师早期识别高危患者并选择最佳诊疗策略。     

急性心肌梗死与高血糖

无论有无糖尿病病史,急性心肌梗死患者常伴有高血糖。急性血糖升高可对心血管造成许多有害影响,并可加重患者的不良转归。强化高血糖控制措施可改善急性心肌梗死患者的预后。因此,提高对急性心肌梗死与高血糖之间相关关系、产生机制及其防治的认识,具有重要的意义。     

Acute Myocardial Infarction During Transesophageal Echocardiography

We describe the occurrence of acute myocardial infarction during transesophageal echocardiography (TEE) in a patient with atrial fibrillation and underestimated angina. Such a case has not been previously reported in the literature. This case illustrates one of the possible complications of TEE, leading us to suggest systematic sedation in patients with angina in whom TEE is envisaged.