直接经皮冠状动脉介入治疗ST段抬高心肌梗死患者预后性别差异的研究  

The role of gender difference on the prognosis of ST-segment elevation myocardial infarction （STEMI） in patients treated with primary percutaneous coronary intervention

作　　者：张波[1,2] 姜大明[1] 孙宇姣[1] 任丽娜[1] 张志红[1] 高远[1] 李玉泽[1] 周旭晨[2] 齐国先[1] 无 

机构地区：[1]中国医科大学第一附属医院,沈阳110001 [2]大连医科大学附属第一医院心内科 [3]代表项目协作组

出　　处：《中华流行病学杂志》2012年第1期92-98,共7页Chinese Journal of Epidemiology

基　　金：辽宁省科学技术计划项目（2008225000-15）

摘　　要：目的研究直接经皮冠状动脉介入治疗（PCI）急性ST段抬高心肌梗死（STEMI）患者住院期间、预后的性别差异以及影响预后的因素。方法2009年6月1日至2010年6月1日在辽宁省20家陕院发病后24h内入院的1429例STEMI患者中，选择直接PCI患者382例，采用统一问卷记录临床资料，并应用统一调套表随访。结果女性患者平均年龄（68．4岁±10．2岁）大于男性（59．9岁±11．5岁），女性患者中位“症状球囊扩张时间”为312．5min，男性为270．0min，差异有统计学意义（P=0.007）；住院期间，女性患者比男性更容易发生心力衰竭、心绞痛及出血，但住院病死率及药物治疗无性别差异。女性与男性患者累及冠状动脉病变支数的差异有统计学意义（P=0．002），但两组间直接PCI成功率的差异无统计学意义。随访1个月时，死亡及其他心血管事件无性别差异；3个月后，女性心力衰竭和因心脏事件再次住院的发生率明显高于男性（均P=0．007），而心血管病死率无性别差异。长期随访女性患者全因病死率高于男性，但差异无统计学意义（4．2％vs．1．6％，P=0．056）。多因素回归分析发现，在校正其他独立因素后，女性不是住院期间及随访期间死亡的独立危险因素。结论直接PCI的STEMI患者中，女性不是住院期间及随访期间死产的独立危险因素。女性患者长期随访病死率上升，是由于其年龄偏大和较长的院前延迟所致。Objective To investigate and analyze the impact of gender difference on outcome and prognosis of ST-segment elevation myocardial infarction （STEMI） in patients treated with primary percutaneous coronary intervention （PCI）. Methods This was a prospective and multicentered observation study. All the patients with acute STEMI admitted to the hospitals from June 1^st 2009 to June 1^st 2010 were continuously recruited. In this study, a unified questionnaire was applied and the 382 patients satisfied the criteria. A unified follow-up questionnaire was used on patients who were discharged from the hospital. Results On average, the female patients were 8 years older than the males. The median ＂symptom-to-balloon time＂ was 312.5 minutes in females and 270.0 minutes in males, and it was significantly different （P=0.007）. During hospitalization, a higher proportion of female patients developed heart failure, angina and bleeding. No gender differences were found on the in-hospital mortality rates and medical therapy recommended by the guideline. The female patients were more prone to multi-vessel disease than males （P=0.002）. Success rates of primary PCI did not show any gender differences. One-month mortality and other cardiovascular events also did not show gender difference when the patients were followed for one month after being discharged. The rates of heart failure and re-hospitalization due to cardiac incidents among female patients were obviously higher than the males, three months after being discharged （P=0.007, respectively）. However, the three-month and long-term cardiac mortality did not show differences related to gender. Female patients were associated with higher all-cause mortality than that in males, but there was no statistically significant difference （female 4.2% vs. male 1.6% ;P=0.056）. Data from multi-factor regression analysis showed that being female was not an independent predictor related to in-hospital mortality or during the follow-up period. Conclusion Being female w

关 键 词：心血管事件 ST段抬高心肌梗死 血管成形术 预后 女性 

分 类 号：R542.22[医药卫生—心血管疾病]