ST段抬高型心肌梗死患者经皮冠状动脉介入治疗后近期和远期预后的性别差异  

Sex Difference in Short-and Long-term Outcomes Among Patients With ST-segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention

作　　者：高斯德 刘青波[1] 丁晓松[1] 陈晖[1] 李虹伟[1] GAO Side;LIU Qingbo;DING Xiaosong;CHEN hui;LI Hongwei(Department of Cardiology,Beijing Friendship Hospital,Capital Medical University,Beijing(100050),China)

机构地区：[1]首都医科大学附属北京友谊医院心脏中心

出　　处：《中国循环杂志》2019年第7期646-652,共7页Chinese Circulation Journal

基　　金：国家自然科学基金(81670315);北京自然科学基金(7172059)

摘　　要：目的:探讨ST段抬高型心肌梗死(STEMI)患者行经皮冠状动脉介入治疗(PCI)后近期和远期预后的性别差异。方法:连续性纳入了2013年1月至2016年1月于北京友谊医院心内科行PCI的STEMI患者909例,按照性别分为男性组(n=703)和女性组(n=206)。比较两组患者的基线特征以及近期和远期的预后情况。近期终点事件为PCI后30天内全因死亡。远期终点事件包括PCI后30个月内主要不良心血管事件(MACE,包括全因死亡、非致死性心肌梗死和血运重建的复合终点)、全因死亡、心原性死亡、非致死性心肌梗死和血运重建。结果:与男性组患者相比,女性组患者的年龄更大,合并高血压及糖尿病的比例更高(P均<0.05),两组患者冠状动脉病变的严重程度以及介入干预的情况差异无统计学意义(P均>0.05)。女性组PCI后30天内全因死亡的发生率显著高于男性组(5.3%vs 1.4%,P=0.001),但女性并非PCI后30天内死亡的独立危险因素(OR=2.41,95%CI:0.64~9.10,P=0.192)。多因素校正后,女性患者PCI后30个月内MACE(HR=0.91,95%CI:0.52~1.60,P=0.762)、全因死亡(HR=0.65,95%CI:0.29~1.45,P=0.300)、心原性死亡(HR=0.62,95%CI:0.27~1.45,P=0.279)、非致死性心肌梗死(HR=0.48,95%CI:0.17~1.36,P=0.172)以及血运重建(HR=1.28,95%CI:0.51~3.22,P=0.598)的发生风险均与男性患者相近,差异无统计学意义。结论:女性STEMI患者在PCI后近期预后较差,全因死亡发生率高,但远期预后与男性患者相似。Objectives:This study investigated the sex difference on short-and long-term outcomes in patients with ST-segment elevation myocardial infarction(STEMI)after percutaneous coronary intervention(PCI).Methods:This study retrospectively analyzed 909 consecutive STEMI patients treated with PCI in Beijing Friendship Hospital from January 2013 to January 2016.Baseline characteristics and cardiovascular outcomes were compared between 703 male and 206 female patients.The short-term endpoint was 30-day mortality after PCI.The long-term endpoint was 30-month major adverse cardiovascular events(MACE,a composite of all-cause death,nonfatal myocardial infarction or revascularization),all-cause death,cardiac death,nonfatal myocardial infarction and revascularization.Results:Compared with male patients,female patients had higher risk profiles associated with old age,hypertension and diabetes(P all<0.05).The severity of coronary lesions and the interventional treatment were similar among male and female groups.As for short-term outcomes,female patients had higher unadjusted 30-day mortality rates than male patients(5.3%vs 1.4%,P=0.001).After multivariate adjustment,sex difference in 30-day mortality rates was no longer observed in STEMI patients(OR=2.41,95%CI:0.64-9.10,P=0.192).In multivariate model for long-term outcomes,female patients had similar risk for 30-month MACE(HR=0.91,95%CI:0.52-1.60,P=0.762),all-cause death(HR=0.65,95%CI:0.29-1.45,P=0.300),cardiac death(HR=0.62,95%CI:0.27-1.45,P=0.279),nonfatal myocardial infarction(HR=0.48,95%CI:0.17-1.36,P=0.172)and revascularization(HR=1.28,95%CI:0.51-3.22,P=0.598)compared with men.Conclusions:In STEMI patients undergoing PCI,female patients have a worse early mortality after PCI but similar long-term outcomes as compared to male patients.

关 键 词：ST段抬高型心肌梗死 经皮冠状动脉介入治疗 心血管预后 性别差异 

分 类 号：R541[医药卫生—心血管疾病]