不同性别急性冠状动脉综合征患者的临床特征与预后

The clinical characteristics and prognosis of non-ST segment elevation acute coronary syndrome in different genders

目的 比较不同性别非ST段抬高急性冠状动脉（冠脉）综合征（NSTEACS）患者临床特征和介入治疗对预后的影响.方法 814例NSTEACS患者,随机接受早期（＜24 h）或延迟（＞36 h）介入治疗,随访6个月,主要联合终点为死亡、心肌梗死（MI）和卒中.结果 女性患者年龄较大、更多有高血压、糖尿病、冠心病史和慢性心绞痛史.但入院时心肌标记物升高者较少,现吸烟者少.女性患者冠脉造影非阻塞性病变的比例高,左主干和（或）3支病变的比例与男性相似.经多因素回归分析,既往MI和严重冠脉病变为女性发生主要终点事件的独立预测因素.严重冠脉病变,延迟介入及至少3种冠心病危险因素是男性发生主要终点事件的独立预测因素.结论 不同性别NSTEACS患者影响预后的因素不同,严重冠脉病变为预后的独立预测因素,早期介入治疗有益于降低男性患者180 d心血管病事件风险,但对女性患者预后无影响.

Objective To determine gender differences in baseline characteristics and intervention treatment in relation to prognosis in patients with non-ST segment elevation acute coronary syndrome （NSTEACS）. Methods A total of 814 patients （545 men and 269 women） with NSTEACS were randomized to early intervention （coronary angiography 〈 24 hours after randomization ） or delayed intervention （coronary angiography〉36 hours after randomization）. The primary outcome was a composite of death, myocardial infarction, or stroke at 6 months. Results Women were older and more frequently had hypertension, diabtetes, and history of coronary artery disease （CAD） or chronic angina （P〈0.05 for all）.Women less were smokers and had elevations in cardiac marker（P 〈 0. 05 for both）. Women who underwent angiography had no significant lesions more often, but the left main stem and/or three-vessel diseases were similar with men. In adjusted multiple logistic regression analysis,the previous myocardial infarction and severe coronary artery disease were independently associated with the risk of primary endpoint in women. On multivariate analysis for men, severe coronary artery disease delayed intervention strategy and at least 3 risk factors for CAD were independently associated with the risk of primary endpoint. Conclusions In NSTEACS patients, different gender had the different prognostic predictor. Severe coronary diseases were as an independent predictor for both male and female patients. An early intervention strategy resulted in a beneficial effect in men which was not seen in women.