摘要
目的 评价我国ST段抬高型心肌梗死（STEMI）患者的治疗及近期预后方面是否存在性别差异.方法 对国际多中心CREATE研究数据库中中国STEMI患者进行回顾性分析.根据性别将患者分成两组,分别比较入院时一般情况及基线临床特征,入院后的再灌注及药物治疗,以及30 d的全因死亡、再梗死、卒中、大出血、心力衰竭以及联合终点事件发生情况,并采用多变量的logistic回归校正影响因素后,比较不同性别患者在治疗及近期预后方面的差异.结果 在入选的7431例患者中,2156例（29.1％）为女性,女性的平均年龄大于男性[（68.2±9.1）岁比（60.3±12.1）岁,P＜0.01].单因素分析显示：女性较男性在入院时心率快（P＜0.01）,舒张压高（P＜0.01）,Killip 分级≥Ⅲ级者多（P＜0.01）.女性患者胸痛发作至入院治疗的时间较男性患者长（P＜0.01）.ST段抬高的部位,男性多表现在前壁导联,女性多表现在下壁及侧壁导联.女性患者既往合并糖尿病、高血压、心力衰竭者多,男性患者既往合并心肌梗死者多（P均＜0.01）.女性患者入院时血糖较高,男性患者血钾浓度较高（P均＜0.01）.住院期间男性患者接受再灌注治疗率显著高于女性（P＜0.01）.药物治疗方面,男性更多的使用氯吡格雷、糖蛋白Ⅱb/Ⅲa抑制剂、β受体阻滞剂、血管紧张素转换酶抑制剂（ACEI）、降脂药物；女性更多的使用阿司匹林与利尿剂（P均＜0.01）.在进行多变量校正后,男女在接受经皮冠状动脉介入治疗方面仍有明显差异（P＜0.01）.女性患者30 d的心血管终点事件如近期死亡、卒中以及心力衰竭发生率均明显高于男性（P＜0.01）,进行多变量校正后,全因死亡性别差异仍有统计学意义（OR=1.425,95％ CI：1.163 ～1.747,P＜0.01）,女性联合终点事件发生率是男性的1.193倍（95％CI：1.010～1.410,P=0.04）.结论 中国STEMI患者在接受再灌注治疗和终点事件方面,确实存在性别差异,女性患者的入院症状较男性严重,接受再灌注治疗率显著低于男性,近期预后较男性差.
with ST-segment elevation myocardial infarction Objective To compare the differences on therapeutic approach and short-term outcomes between male and female patients with ST-elevation myocardial infarction （ STEMI ）.Methods Data of Chinese STEMI patients were retrospectively analyzed from a global multicenter clinical trial of reviparin and metabolic modulation in acute myocardial infarction treatment evaluation （CREATE）. The patients were divided into two groups according to gender and difference on demographic,baseline clinical characteristics at admission, reperfusion and drug therapy and 30-day all-cause mortality, re-infarction, stroke,hemorrhage,heart failure and combined end points were compared.Results Of the 7431 patients,29.1%were female.Female patients were older than male patients [ （ 68.2 ± 9.1 ） years vs.（ 60.3 ± 12.1 ）years ].On admission,heart rate,diastolic blood pressure and Killip class were higher and the delay between onset of chest pain and arrival at hospital was longer in female patients than in male patients （ all P 〈0.01 ）.Male patients often presented MI in anterior leads while female patients often presented MI in inferior and lateral leads.History of diabetes mellitus,hypertension and heart failure was significantly higher in female than in male patients （ all P 〈0.01 ）.Incidence of high blood glucose was higher in female while high blood potassium was higher in male patients （ P 〈 0.01 ）.Rate of reperfusion therapy was lower and the use aspirin and diuretic was more frequent in female patients than in male patients,while frequency of clopidogrel,Glycoprotein Ⅱ b/Ⅲ a receptor inhibitor,β-blockers,angiotensin converting enzyme inhibitor,lipid-lowering drug use was significantly higher in male than in female patients （ all P 〈 0.01 ）. Multivariate logistic regression analysis showed that female gender was a predictor for less PCI therapy （P 〈 0.01 ）.Thirty-day all cause mortality（ OR =1.425,95% CI：1.163 - 1.747,P 〈 0.01 ） and combined end points （ OR =1.193,95%CI：1.010- 1.410,P =0.04） were significantly higher in female patients than in male patients.Conclusions There are gender-related differences on therapeutic approach and short-term outcome in Chinese STEMI patients.The unfavorable demographic and baseline clinical profile could partially explain the less reperfusion therapy rate and worse prognosis in female patients .
出处
《中华心血管病杂志》
CAS
CSCD
北大核心
2012年第2期108-114,共7页
Chinese Journal of Cardiology
关键词
心肌梗死
性别特征
预后
Myocardial infarction
Gender identity
Prognosis
