性别对急性ST段抬高心肌梗死患者预后的影响  

Impact of gender on the outcome of patients with acute ST-elevation myocardial infarction

作　　者：李超[1] 胡大一[2] 李洁[1] 杨进刚[3] 宋莉[3] 马长生[4] 

机构地区：[1]首都医科大学附属北京同仁医院心血管中心,100730 [2]北京大学人民医院心内科 [3]中国医学科学院阜外心血管病医院心脏中心 [4]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所心内科

出　　处：《心肺血管病杂志》2015年第5期339-343,共5页Journal of Cardiovascular and Pulmonary Diseases

基　　金：首都紧急医学救援(5分钟)科技工程建设研究项目[京科技发(2005)593]

摘　　要：目的：评价性别对急性ST段抬高心肌梗死患者院内和长期预后的影响。方法：连续入选793例发病后24h内至北京市19家医院就诊的STEMI患者,中位随访5.7年,根据性别分为两组,比较两组临床特点和院内预后及长期随访情况。结果：与男性相比,女性年龄较大、既往有高血压、糖尿病、心力衰竭病史者较多,吸烟者少,入院时合并肾功能不全、Killip II级以上者比例增高,女性患者舒张压偏低,从症状发作到医院时间较长、接受急诊再灌注治疗比例较低（P〈0.05）。院内死亡（10.7%vs.4.1%,P=0.001）、恶性心律失常（14.9%vs.7.9%,P=0.007）、主要心血管事件（MACE）（31.8%vs.22.1%,P=0.01）和6年全因死亡（21.6%比13.8%,P=0.03）均显著增高。多因素分析显示校正年龄后性别不是STEMI患者院内死亡（OR=1.482,95%CI：0.716-3.070,P=0.289）和6年全因死亡（RR=0.948,95%CI：0.465-1.933,P=0.883）的独立危险因素。结论：女性STEMI患者院内和长期随访病死率高与年龄大、危险因素及合并症多、再灌注治疗比例低有关,性别不是影响STEMI患者院内和长期预后的独立危险因素。Objective： To evaluate the impact of gender on the outcomes of patients with acute ST-elevated myocardial infarction（ STEMI）. Methods： This was a multicentre,prospectivecohort study. 793 patients were admitted to 19 hospitals in Beijing within 24 h of onset of chest pain between January 1,2006 and December 31,2006. 495 patients were followed-up successfully by telephone between April 1,2012 and June 31,2012. The patients were categorized according to gender,clinical characteristics,reperfusion therapy and outcomes were analyzed. Multivariate Logistic and Cox regression analysis was used to evaluate the impact of gender on patients＇ in-hospital and long-term mortality. Results： Female patients were older,presented more hypertension,diabetes,heart failure,renal dysfunction and smoker. Lower diastolic blood pressure and higher killip classification on admission were seen in female patients. The delay between onset of chest pain and hospital was longer than in male patients,rate of reperfusion was lower in female patients than in male patients. Female group also presented higher in-hospital mortolity（ 10. 7% vs. 4. 1%,P = 0. 01）,malighant arhythmias（ 14. 9%vs. 7. 9%,P = 0. 07）,MHCE（ 31. 8% vs. 22. 1%,P = 0. 01） and 6-year all-cause mortality（ 21. 6% vs.13. 8%,P = 0. 03）. After adjustment for age,gender was not associated with in-hospital mortality [OR = 1. 482,95% CI： 0. 716- 3. 070,P = 0. 289] and long-term mortality [OR = 0. 943,95% CI： 0. 465- 1. 933,P =0. 883]. After multivariable adjustment,age（ every ten years） [OR = 1. 840,95% CI： 1. 253- 2. 701,P =0. 002）,history of stroke [OR = 2. 972,95% CI： 1. 238- 7. 132,P = 0. 015],antior infarction [OR = 2. 612,95% CI： 1. 105- 6. 171,P = 0. 029],killip classifation（ every class） [OR = 3. 169,95% CI： 1. 383- 7. 263,P = 0. 006] and therapy of reperfusion[OR = 0. 863,95% CI： 1. 030- 2. 260,P = 0. 037] were independent predictors of in-hospital mortality,age（ every ten years） [OR = 2. 061,95% CI： 1. 324- 3. 208,P = 0

关 键 词：急性心肌梗死 性别 院内预后 长期预后 

分 类 号：R54[医药卫生—心血管疾病]