性别差异对急性心肌梗死再灌注治疗的影响

Gender-related differences in patients undergoing reperfusion therapy for acute myocardial infarction

目的 评价性别差异对急性心肌梗死再灌注治疗预后的影响。方法 收集 1999年 1月～ 2 0 0 3年9月接受再灌注治疗的急性心肌梗死患者 32 5例 ,按性别分为女性组 (84例 )和男性组 (2 4 1例 ) ;其中 172例接受直接经皮冠状动脉成形术 (PCI组 ) ,15 3例进行静脉溶栓 (静脉溶栓组 ) ,记录住院期间所有死亡原因、非致死性再梗死及其复合终点事件以及 6个月随访期间心脏事件的情况。结果 女性组的平均年龄为 (6 9.3± 10 .2 )岁 ,明显高于男性组的 (6 0 .7± 12 .6 )岁 (P <0 .0 1) ,且合并高血压、糖尿病比例明显增高 (P <0 .0 5 )。对年龄作校正后 ,住院期间女性的死亡率与男性的差异无显著性 (P >0 .0 5 ) ,其他各主要及次要终点事件的差异均无显著性。静脉溶栓组中 ,女性死亡率高于男性 (P <0 .0 5 ) ;PCI组中 ,男、女患者死亡率的差异无显著性 (P >0 .0 5 )。结论 尽管女性较男性高龄且糖尿病、高血压的发病率也较高 。

Objective To assess the impact of gender on the outcomes of AMI patients treated with reperfusion therapy. Methods From January 1999 to September 2003, 325 consecutive AMI patients underwent reperfusion therapy(172 PCI,153 thrombolysis), All patients were divided into female group(84 cases)and male group (241 cases). The overall mortality rate of nonfatal MI, and composite in-hospital endpoint events were recorded and the patients were followed up for 6 months as regard to cardiac complications. Results Compared with the males, the females were older [(69.3±10.2) years vs (60.7±12.6) years; P<0.01], the incidence of diabetes and hypertension were higher (P<0.05). After age adjustment, there were no significant differences in mortality rate between the two groups during hospitalization(P>0.05) including the main endpoint and secondary endpoint events. Subgroups analysis showed the mortality rate in the females was higher(P<0.05) in the thrombolysis group. In the PCI group, the difference was non-significant. Conclusion Despite older age and greater prevalence of diabetes and hypertension, the female AMI patients treated with primary PCI showed similar outcomes as the males.