男女性别差异对于行急诊经皮冠状动脉成形术治疗患者预后影响分析

Effect of gender difference on the follow-up outcomes for patients undergoing primary PCI

目的探讨在药物涂层支架时代,行急诊PCI治疗的急性ST段抬高心肌梗死(STEMI)患者中,不同性别患者的PCI预后差异。方法连续纳入687例行急诊PCI治疗的STEMI患者,其中男572例,女115例。比较不同性别患者的基线特征、手术结局及临床预后。结果女性患者发病的平均年龄大于男性,合并多支病变的比例也要高于男性。女性患者院内(3.8%vs.4.3%,P=0.792)及1年期(6.6%vs.7.8%,P=0.647)的主要不良心血管事件率与男性无统计学差异。但女性院内的大出血事件(11.3%vs.5.4%,P=0.019)及穿刺并发症(9.6%vs.4.9%,P=0.048)要高于男性。女性患者一年随访时的再发心绞痛事件率也要高于男性(10.4%vs.3.9%,P=0.003)。结论在药物涂层支架时代,对于行急诊PCI治疗的STEMI患者,不同性别间的近期及1年期的主要临床终点预后相似。但女性的出血及穿刺点并发症风险更高。合理的避免出血是提升女性PCI质量的首要目标。

Objective To evaluate the effect of gender difference on the follow-up outcomes for STEMI patients undergoing primary PCI in the era of drug-eluting stents. Methods 687 STEMI patients who have undergone primary PCI were consecutively recruited. The baseline features, procedure outcomes and clinical prognosis were compared between men and women. Results Women were older, and accompanied with a higher rate of multivessel disease. The rates of in-hospital and 1 year major adverse cardiovascular events（MACE） were similar between men and women（3.8% vs. 4.3%, P=0.792, 6.6% vs. 7.8%, P=0.647）. Women had higher rates of major bleeding（11.3% vs. 5.4%, P=0.019） and access site complications（9.6% vs. 4.9%, P=0.048） compared with men. The recurrent angina was more frequent in women than in man at 1 year follow-up（10.4% vs. 3.9%, P=0.003）. Conclusions There is no gender difference with the short-term or 1 year outcomes for STEMI patients undergoing primary PCI, but women have a higher risk of bleeding and access site complications. To avoid bleeding is the major goal in elevating the PCI quality in women.