CAJ | 학술논문

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家医院发病后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,并应用统一调查表随访.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312.5 min,男性为270.0 min,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亡的独立危险因素.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.
목적 연구직접경피관상동맥개입치료(PCI)급성ST단태고심기경사(STEMI)환자주원기간、예후적성별차이이급영향예후적인소.방법 2009년6월1일지2010년6월1일재요녕성20가의원발병후24h내입원적1429례STEMI환자중,선택직접PCI환자382례,채용통일문권기록림상자료,병응용통일조사표수방.결과 녀성환자평균년령(68.4세±10.2세)대우남성(59.9세±11.5세),녀성환자중위“증상구낭확장시간”위312.5 min,남성위270.0 min,차이유통계학의의(P=0.007);주원기간,녀성환자비남성경용역발생심력쇠갈、심교통급출혈,단주원병사솔급약물치료무성별차이.녀성여남성환자루급관상동맥병변지수적차이유통계학의의(P=0.002),단량조간직접PCI성공솔적차이무통계학의의.수방1개월시,사망급기타심혈관사건무성별차이;3개월후,녀성심력쇠갈화인심장사건재차주원적발생솔명현고우남성(균P=0.007),이심혈관병사솔무성별차이.장기수방녀성환자전인병사솔고우남성,단차이무통계학의의(4.2％ vs.1.6％,P=0.056).다인소회귀분석발현,재교정기타독립인소후,녀성불시주원기간급수방기간사망적독립위험인소.결론 직접PCI적STEMI환자중,녀성불시주원기간급수방기간사망적독립위험인소.녀성환자장기수방병사솔상승,시유우기년령편대화교장적원전연지소치.
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 1st 2009 to June 1st 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 was not an independent predictor of in-hospital mortality or during follow-up period among patients who were treated with primary PCI.Worse long-term outcome seen in female patients was likely to be explained by older age or longer pre-hospital delayed time.