摘要
目的 了解再灌注治疗时代女性急性心肌梗死患者近期预后情况及其影响因素.方法 连续入选2011年6月至2012年5月入住冠心病监护病房的72 h内急性心肌梗死患者471例,男性368例（78.1％）,女性103例（21.9％）,观察比较男性与女性患者临床特点、治疗方法、并发症、30 d死亡及主要不良心脑血管事件.结果 与男性患者比较,女性患者的年龄[（66.8±10.1）岁比（56.9±12.0）岁,P＜0.001]、心肌梗死溶栓试验（TIMI）评分（5.1±2.3比3.9±2.1,P＜0.001）和GRACE评分（162±39比142±35,P＜0.001）均较高.女性患者因病变复杂或禁忌证不能行介入治疗者比例更高（P=0.015）,而支架置人比例更低（P=0.038）；发生机械并发症、二尖瓣反流、恶性心律失常、梗死后心绞痛、对比剂肾病和消化道小量出血的比例均高于男性（P均＜0.05）,30 d病死率明显高于男性[5.8％（6/103）比1.9％（7/368）,P=0.032],主要不良心脑血管事件发生率[10.7％（11/103）比5.4％（20/368）,P=0.058]有增高趋势但差异无统计学意义.多因素回归分析显示,性别不是30 d死亡（P=0.141）和主要不良心脑血管事件（P =0.426）的独立危险因素；就诊时收缩压（OR=1.072,95％CI：1.016 ～1.130,P=0.010）及梗死后心包积液（P=0.044,OR =40.518,95％CI：1.098～ 1495.702）是30 d死亡的独立危险因素,就诊时收缩压（P =0.036,OR=1.027,95％ CI：1.002～1.052）及左心室射血分数（OR=1.108,95％ CI：1.032～1.190,P=0.005）是30 d主要不良心脑血管事件的独立危险因素.结论 女性急性心肌梗死患者高龄、病情危重且并发症发生率高,但性别本身并非预测近期死亡及主要不良心血脑管事件的独立危险因素.
Objective To evaluate the gender differences on the short-term outcomes of patients with acute myocardial infarction in the real world.Methods A total of 471 consecutive patients [male 368（78.1%） and female 103（21.9%）] with acute myocardial infarction 〈72 hours in cardiac care unit were included.The clinical data,death and major adverse cardiac and cerebrovascular events at 30 days post hospitalization were analyzed.Results Female patients were older （66.8 ± 10.1 vs.56.9-± 12.0,P 〈0.001）,TIMI score （5.1 ±2.3 vs.3.9 ±2.1,P〈0.001） and GRACE score （162 ±39 vs.142 ±35,P〈0.001） in female patients were higher than in male patients.Female patients had lower proportion of stent implantation （P =0.038） while higher percentage of complex lesions and contraindications to PCI （P=0.015） compared to male patients.Proportion of cardiac rupture,mitral regurgitation,malignant arrhythmia,post-infarction angina pectoris,contrast-induced nephropathy and minor gastrointestinal bleeding were also higher in female patients tan in male patients （P 〈 0.05）.Thirty-day mortality was significantly higher in female patients than in male patients [5.8% （6/103） vs.1.9% （7/368）,P =0.032],MACCE [10.7% （11/103） vs.5.4% （20/368）,P =0.058] also tended to be higher in female patients than in male patients.Multi-logistic regression analysis showed that female gender was not an independent predictor for thirty-day mortality （P =0.141） or MACCE （P =0.426） while systolic blood pressure （OR =1.072,95% CI：1.016-1.130,P =0.010） and pericardial effusion after myocardial infarction （OR =40.518,95% CI：1.098-1495.702,P =0.044） were independent predictors for thirty-day mortality while systolic blood pressure （OR =1.027,95% CI：1.002-1.052,P =0.036） and left ventricular ejection fraction （OR =1.108,95% CI：1.032-1.190,P =0.005） were independent predictors for MACCE.Conclusions Female gender itself is not an independent predictor for thirty-day mortality and MACCE despite poorer clinical characteristics,higher incidence of complications,and worse prognosis in female patients.
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2013年第10期826-832,共7页
Chinese Journal of Cardiology
关键词
心肌梗死
血管成形术
经腔
经皮冠状动脉
女性
预后
Myocardial infarction
Angioplasty, transluminal, percutaneous coronary
Female
Prognosis
作者简介
通信作者：杨跃进，Email：yangyjfw@yahoo．com．cn
