经皮冠状动脉介入治疗急性心肌梗死患者30 d和远期病死率与性别的相关性分析  

Correlation between 30-day and long-term mortality and sex in patients with acute myocardial infarction treated by percutaneous coronary intervention

作　　者：李健洪 朱杏谊 LI Jian-hong;ZHU Xing-yi(The Sixth Affiliated Hospital of Guangzhou Medical University,No.2 Department of Cardiology of Qingyuan City People′s Hospital,Qingyuan,Guangdong 511518,China;The Sixth Affiliated Hospital of Guangzhou Medical University,Clinical Laboratory of Qingyuan City People′s Hospital,Qingyuan,Guangdong 511518,China)

机构地区：[1]广州市医科大学附属第六医院清远市人民医院心血管内科二区,广东清远511518 [2]广州市医科大学附属第六医院清远市人民医院检验科,广东清远511518

出　　处：《岭南心血管病杂志》2018年第4期408-411,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨性别与经皮冠状动脉介入(percutaneous coronary intervention,PCI)治疗急性心肌梗死(acute myo-cardial infarction,AMI)患者30 d和远期病死率的相关性。方法选取2010年8月至2017年7月于清远市人民医院进行PCI治疗的AMI患者共3 624例的临床资料进行回顾性分析,其中女性比例为30.6%。记录对比不同性别患者的临床特征,观察不同性别对30 d和远期病死率的影响。多变量逻辑回归模型用于分析30 d病死率和Cox回归分析用于分析远期病死率。随访时间中位数为27个月。结果女性患者的30 d病死率(9.5%vs.5.9%,P<0.05)和远期病死率(19.0%vs.13.5%,P<0.05)显著高于男性患者,差异均有统计学意义。在倾向匹配分析中,女性患者与30 d病死率(OR=1.46,95%CI:0.97~2.19)或远期病死率(OR=1.02,95%CI:0.81~1.28)无显著相关;年龄>77岁,心源性休克,左前降支(left anterior descending,LAD)PCI治疗,PCI治疗后冠状动脉心肌梗死溶栓试验(thrombolysisin myocardial infarction,TIMI)血流<3级、原发性高血压(高血压)、血脂异常和P2Y12受体拮抗剂被认为是30 d和远期病死率的独立预测因子;此外,肾功能衰竭需要透析可用于预测远期病死率。结论年龄较大、并发症、临床表现不佳、辅助性药物治疗而不是性别,是女性AMI患者PCI治疗病死率高的主要原因。Objectives To investigate the association between sex and 30-day and long-term mortality in patients with acute myocardial infarction(AMI)treated by percutaneous coronary intervention(PCI).Methods A total of 3 624 patients′clinical characteristics with AMI who underwent PCI in Qingyuan City People′s Hospital from August 2010 to July 2017 were retrospectively analyzed.The proportion of women was 30.6%.Clinical characteristics of different sexes were compared and effects of different sex on 30-day and long-term mortality were observed.Multivariate Logistic regression model was used to analyze 30-day mortality and Cox regression analysis for the analysis of long-term mortality.Results The 30-day mortality(9.5%vs.5.9%,P<0.05)and long-term mortality(13.5%vs.19.0%,P<0.05)were significantly higher in female patients than in male patients.Tendency matching analysis indicated that female patients had no significant association with 30 days mortality(OR=1.46,95%CI:0.97-2.19)and long-term mortality(OR=1.02,95%CI:0.81-1.28);but age>77 years old,cardiogenic shock,PCI for left anterior descending(LAD),thrombolysis in myocardial infarction(TIMI)blood flow<3 degree,hypertension,dyslipidemia and P2Y12 receptor antagonist were independent predictors of 30-day and long-term mortality.In addition,renal failure requiring dialysis was used to predict long-term mortality.Conclusions Advanced age,complications,poor clinical manifestations,adjuvant drug therapy rather than gender are the main causes for a female AMI patients with high PCI mortality.

关 键 词：心肌梗死 经皮冠状动脉介入治疗 病死率 性别 

分 类 号：R542.22[医药卫生—心血管疾病]