CAJ | 학술논문

75岁及以上不同性别老年冠心病患者经皮冠状动脉介入治疗术后的预后分析
75세급이상불동성별노년관심병환자경피관상동맥개입치료술후적예후분석
Gender differences of the in-hospital and follow-up outcomes in elderly patients undergoing percutaneous coronary intervention

万方数据

中国心血管杂志中國心血管雜誌 중국심혈관잡지
CHINESE JOURNAL OF CARDIOVASOLOGY
2014年 4期 241-245 ,共5页

何培源%杨跃进%乔树宾%徐波%吴永健%袁晋青%陈珏%刘海波%唐欣然%王杨%李卫%高润霖

하배원%양약진%교수빈%서파%오영건%원진청%진각%류해파%당흔연%왕양%리위%고윤림

老年人%女性%冠状动脉疾病%血管成形术%预后老年人%女性%冠狀動脈疾病%血管成形術%預後
노년인%녀성%관상동맥질병%혈관성형술%예후
Aged%Women%Coronary artery disease%Angioplasty%Prognosis

目的：探讨不同性别的老年冠心病患者行经皮冠状动脉介入治疗( PCI)后,短期及1年期预后的差异。方法前瞻性连续纳入行PCI治疗的75岁以上老年患者1105例,其中男性739例,女性366例。比较两组患者的临床基线特征、手术结局及临床预后。结果老年男性患者的吸烟率(20.3%比5.7%,χ2=39.670)、心肌梗死病史(27.9%比19.9%,χ2=8.156)及肌酐异常比例(20.2%比10.9%,χ2=14.718)均高于女性(均为 P ﹤0.01)；而老年女性患者的高血压患病率(73.2%比65.8%,χ2=6.284, P ﹤0.01)、血红蛋白异常比例(20.5%比15.8%,χ2=3.702, P =0.054)均高于男性。老年男性患者采用血管内超声的比例高于女性(5.8%比1.9%,χ2=8.645,P﹤0.01),选用桡动脉路径的比例也高于女性(79.6%比73.2%,χ2=5.642,P=0.02)。老年女性患者的院内净不良临床事件率显著高于男性(7.7%比3.9%,χ2=6.946,P﹤0.01),主要源于穿刺点相关的大出血事件率的差异(3.0%比0.5%,χ2=11.100,P﹤0.01)。老年男性与女性患者1年期主要不良心血管事件率差异无统计学意义(6.2%比7.9%,χ2=1.117,P=0.29)；同时1年期的死亡、心肌梗死、靶血管重建事件率差异也无统计学意义(均为P﹥0.05)。结论行PCI治疗的老年女性患者院内净不良临床事件率高于男性患者,主要为穿刺点相关的大出血事件的差异。对老年女性患者的穿刺点进行有效管理是提高PCI质量的重要方式。
목적：탐토불동성별적노년관심병환자행경피관상동맥개입치료( PCI)후,단기급1년기예후적차이。방법전첨성련속납입행PCI치료적75세이상노년환자1105례,기중남성739례,녀성366례。비교량조환자적림상기선특정、수술결국급림상예후。결과노년남성환자적흡연솔(20.3%비5.7%,χ2=39.670)、심기경사병사(27.9%비19.9%,χ2=8.156)급기항이상비례(20.2%비10.9%,χ2=14.718)균고우녀성(균위 P ﹤0.01)；이노년녀성환자적고혈압환병솔(73.2%비65.8%,χ2=6.284, P ﹤0.01)、혈홍단백이상비례(20.5%비15.8%,χ2=3.702, P =0.054)균고우남성。노년남성환자채용혈관내초성적비례고우녀성(5.8%비1.9%,χ2=8.645,P﹤0.01),선용뇨동맥로경적비례야고우녀성(79.6%비73.2%,χ2=5.642,P=0.02)。노년녀성환자적원내정불량림상사건솔현저고우남성(7.7%비3.9%,χ2=6.946,P﹤0.01),주요원우천자점상관적대출혈사건솔적차이(3.0%비0.5%,χ2=11.100,P﹤0.01)。노년남성여녀성환자1년기주요불양심혈관사건솔차이무통계학의의(6.2%비7.9%,χ2=1.117,P=0.29)；동시1년기적사망、심기경사、파혈관중건사건솔차이야무통계학의의(균위P﹥0.05)。결론행PCI치료적노년녀성환자원내정불량림상사건솔고우남성환자,주요위천자점상관적대출혈사건적차이。대노년녀성환자적천자점진행유효관리시제고PCI질량적중요방식。
Objective To evaluate the gender differences of the short-term and 1-year outcomes in elderly patients undergoing PCI. Methods The 1 105 elderly patients undergone PCI were consecutively recruited. Among them, 739 were males, 366 were females. The clinical features, procedure outcomes and clinical prognosis were compared between the two groups. Results The prevalence of smoking (20. 3% vs. 5. 7%,χ2 =39. 670, P﹤0. 01), prior myocardial infarction (27. 9% vs. 19. 9%,χ2 =8. 156, P﹤0. 01) as well as the proportion of abnormal serum creatine (20. 2% vs. 10. 9%, χ2 =14. 718, P﹤0. 01) were significantly higher in men than in women. The prevalence of hypertension ( 73. 2% vs. 65. 8%, χ2 =6. 284, P﹤0. 01) as well as the proportion of anemia (20. 5% vs. 15. 8%, χ2 =3. 702, P=0. 054) was significantly higher in women than in men. The rates of intravascular ultrasound ( 5. 8% vs. 1. 9%, χ2 =8. 645, P﹤0. 01)and radial access (79. 6% vs. 73. 2%,χ2 =5. 642, P=0. 02) were significantly higher in men than in women. The rate of in-hospital NACE was significantly higher in women than in man (7. 7%vs. 3. 9%,χ2 =6. 946, P﹤0. 01), mainly driven by the higher rate of access site-related major bleeding (3. 0% vs. 0. 5%, χ2 =11. 100, P ﹤0. 01 ) . No significant difference was detected of 1 year MACE between men and women (6. 2% vs. 7. 9%, χ2 =1. 117, P=0. 29), and the rates of death, myocardial infarction and target vessel revascularization were also similar between men and women ( all P ﹥0. 05 ) . Conclusions The in-hospital NACE is significantly higher in elderly women compared with elderly men who have undergone PCI, which is mainly driven by the difference of access site-related major bleeding. Proper management of the access site bleeding is an effective way in improving PCI quality in elderly women.