急性冠脉综合征患者介入治疗后生存时间的性别差异

A Perspective Study on the Sex Difference in Survival Time of Patients with Acute Coronary Syndrome after Percutaneous Coronary Intervention

目的:比较急性冠脉综合征(ACS)经皮冠脉介入治疗(PCI)患者的特征、处置与死亡率在性别方面的差异。方法:收集2001-2005年ACS行PCI142例男性和78例女性患者资料并随访至2006年,比较患者的特征、处置与死亡率在性别方面的差异。结果:在随访期有17例(11.97%)男性和13例(16.67%)女性患者死亡。单因素分析显示女性有较高的死亡率(风险率1.47,95%CI为1.22～1.73,P<0.01),但经过年龄、肥胖、吸烟、并存疾病、心血管病病史、糖尿病、高血压和情感抑郁等多因素调整后无差异(风险率1.05,95%CI为0.86～1.21,P>0.05)。同样PCI后1月内女性有较高的死亡率(风险率1.55,95%CI为1.27～1.86,P<0.01),但经过上述多因素调整后无差异(风险率1.05,95%CI为0.82～1.31,P>0.05)。分析男女组别PCI情况,发现两组病变血管、支架数目、支架直径、即刻成功率及术中并发症差异均无显著性(均P>0.05)。结论:结果与有关ACS行PCI后女性预后差的报道有所不同。差别的主要原因在于患者的年龄、处置和多因素的影响,提示如果女性患者能及时得到相同的处置则生存率将与男性相同。

Objective： To study the sex differences in clinical characteristics, treatment principle, and mortality of patients with acute coronary syndrome （ACS） and treated by percutaneous coronary intervention （PCI）. Methods： Archive information of 142 men and 78 women with ACS after PCI between 2001 and 2005, and the following up observation information of the patients by the end of 2006 were analyzed. The patients＇ characteristics, their treatment, and mortality differences between male and female were compared. Results： Seventeen（ 11. 97% ）men and Thirteen （16. 67% ） women died during a following up observation. Univariate analysis indicated a higher mortality in women [ hazard ratio （HR） 1.47, 95% CI 1.22 - 1.73, P 〈0. 01 ] than in men, but the difference disappeared when adjusted with factors of age, morbid obesity, smoking, co-morbidity, previous vascular disease, diabetes, hypertension, and social isolation（ HR1.05, 95% CI 0. 86 - 1.21 ,P 〉0. 05）. There was also a higher mortality within 1 month after PCI in women（ HR1.55,95% CI 1.27 - 1.86 ,P 〈0. 01 ） than in men, but this did not retain significance when adjusted for the same covariates （HR1.05, 95% CI 0. 82 - 1.31, P 〉 0. 05 ）. No other differences were found in PCI procedural character between the two genders（P 〉0. 05）. Conclusions： The results of this research differ from those reported in other studies. The reason might be that the age, treatment and other factors of studied subjects are different. The study results suggest survival rate of female patients can be the same as that of male patients if female patients could get same quality of care as males in time.