文章摘要
张波,姜大明,孙宇姣,任丽娜,张志红,高远,李玉泽,周旭晨,齐国先.直接经皮冠状动脉介入治疗ST段抬高心肌梗死患者预后性别差异的研究[J].中华流行病学杂志,2012,33(1):92-98
直接经皮冠状动脉介入治疗ST段抬高心肌梗死患者预后性别差异的研究
The role of gender difference on the prognosis of ST-segment elevation myocardial infarction(STEMI)in patients treated with primary percutaneons coronary intervention
收稿日期:2011-06-18  出版日期:2014-09-10
DOI:
中文关键词: 心血管事件;ST段抬高心肌梗死;血管成形术;预后;女性
英文关键词: Cardiovascular event;ST-elevation myocardial infarction;Reperfusion therapy;Prognosis;Female
基金项目:辽宁省科学技术计划项目(2008225009—15)
作者单位E-mail
张波 中国医科大学第一附属医院, 沈阳 110001
大连医科大学附属第一医院心内科 
 
姜大明 中国医科大学第一附属医院, 沈阳 110001  
孙宇姣 中国医科大学第一附属医院, 沈阳 110001  
任丽娜 中国医科大学第一附属医院, 沈阳 110001  
张志红 中国医科大学第一附属医院, 沈阳 110001  
高远 中国医科大学第一附属医院, 沈阳 110001  
李玉泽 中国医科大学第一附属医院, 沈阳 110001  
周旭晨 大连医科大学附属第一医院心内科  
齐国先 中国医科大学第一附属医院, 沈阳 110001 Email:qigx2002@medmail.coal.cn 
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中文摘要:
      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。
英文摘要:
      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.
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