年龄和性别对急性心肌梗死住院患者预后的影响

Impact of age and sex on in-hospital outcomes of patients with acute myocardial infarction

目的：探讨年龄和性别对急性心肌梗死（AMI）住院患者预后的影响。方法：回顾性研究1994年1月至2004年12月期间在我院住院且未行再灌注治疗的全部AMI病例，对比不同年龄和性别AMI患者住院期间缺血复发（包括心绞痛和再梗死）、心力衰竭和死亡发生率的差异。结果：共有1315例患者入选，男性897例，女性418例。在≤60岁，61～80岁和≥81岁三个不同的年龄组，女性患者比例随年龄的增长而增加（分别为18．4％、37．8％和53．8％，P均〈0．05）；心力衰竭和死亡的发生率随年龄的增长而增加（分别为16．0％、30．0％、49．2％和4．1％、10．0％、32．3％，P均〈0．05）；缺血复发率无统计学意义。女性患者住院期间心力衰竭和死亡的发生率高于男性患者（分别为34．4％vs22．1％，P〈0．001；11．7％vs7．8％，P〈0．05），排除年龄因素后，性别对死亡率的影响无统计学意义。结论：AMI患者住院期间心力衰竭和死亡的发生率随年龄增长而增加；女性患者心力衰竭发生率显著高于男性，死亡率也高于男性．但排除年龄因素后，不同性别死亡率的差异未达统计学意义。

Objective： To evaluate the impact of age and sex on in-hospital outcomes of patients with acute myocardial infarction（AMI）. Methods： A retrospective study was carried out in patients with AMI who were admitted to Qilu hospital from January 1994 to December 2004 and had never experienced any sorts of reperfusion therapy including thrombolysis, primary percutaneous coronary intervention （PCI） and CABG within the first 24 hours after symptom onset. Results： A total of 1,315 patients including 897 males and 418 females were enrolled in this study. The distribution of ages was： ≤60 years, 462 patients （35.1%）, 61 to 80 years, 788（59.9%）, ands≥81 years,65 （4.9%） and the relative proportion of females increased with age（18.4% ,37.8% and 53.8% ,all P 〈0.05）. Higher prevalence of in-hospital heart failure （16.0% ,30.0% and 49.2% for ≤60, 61 to 80, and ≥81 years, respectively） and death（4. 1%, 10.0% and 32.3% for ≤60, 61 to 80, and≥81 years, respectively） was associated with age, too. There was no significant difference on the incidence of ischemic events including unstable angina pectoris and reinfarction among different age groups. Females were more likely to have heart failure and death during hospitalization than males（34.4% vs 22.1%, P 〈 0.001）. However, the difference on in-hospital mortality between males and females disappeared after being adjusted with age. Conclusions： The incidence of in-hospital heart failure and death increases with age. Females are liable to have heart failure and death during hospitalization than males. However, the difference on in-hospital mortality between males and females disappears after being adjusted with age.