女性急性心肌梗死患者的临床特点及预后分析

Clinical features of female patients with acute myocardial infarction and their outcomes

目的：评价女性与男性急性心肌梗死（AMI）患者的临床特点及预后。方法连续入选AMI患者284例，男216例，女68例，比较女性与男性患者临床特点、合并症、PCI及院内预后的差异，随访3个月主要不良心血管事件（M ACE），评价影响患者死亡及 M ACE的危险因素。结果与男性比较，女性患者年龄偏大、入院时心率偏快、TIMI分级及GRACE评分明显升高（P＜0．05，P＜0．01）。女性冠状动脉造影比例明显降低（30．9％ vs 48．6％， P＝0．012）；院内死亡有增高趋势，但差异无统计学意义（17．6％ vs 9．3％，P＝0．077），3个月MACE发生率高于男性（27.9％ vs 15．7％，P＝0．032）。多因素logistic回归分析显示，年龄（OR＝1．078，95％ CI：1．035～1．123，P＝0．000）和Killip分级（OR＝1．901，95％ CI：1．373～2．633，P＝0．000）是院内死亡的独立危险因素；年龄（OR＝1.040，95％ C I：1．008～1．074，P＝0．015）、Killip分级（OR＝1．543，95％ C I：1．170～2．034，P＝0．002）是3个月MACE的独立危险因素；PCI（OR＝0．090，95％ CI：0．026～0．306，P＝0．000）是3个月MACE的保护因素。结论女性AMI患者年龄偏大、心功能差、危险程度高，接受 PCI比例低，但性别本身并非预测院内死亡及3个月随访M ACE的独立预测因素。

Objective To assess the clinical features of female patients with AMI and their out-comes .Methods Two hundred and eighty-four AMI patients （216 males and 68 females） were in-cluded in this study .Their clinical features ,complications ,PCI and outcomes were comared .The patients were followed up for 3 months ,during which the major adverse cardiac events （MACE） were observed with their mortality and risk factors for MACE assessed .Results The age was ol-der and the heart rate ,TIMI grade ,GRACE score were significantly higher in female patients than in male patients （P〈0 .05 ,P〈0 .01） .The ratio of female patients who underwent PCI was signif-icantly lower than that of male patients who underwent PCI （30 .9% vs 48 .6% ,P=0 .012） .The in hospital mortality was higher in female patients than in male patients （17 .6% vs 9 .3% ,P=0.077） ,and the incidence of MACE in a 3-month follow-up period was significantly higher in fe-male patients than in male patients （27 .9% vs 15 .7% ,P=0.032） .Multivariate logistic regression analysis showed that age and Killip classification were the independent risk factors for in hospital mortality （OR=1 .078 ,95% CI：1 .035 -1 .123 ,P=0 .000 ;OR= 1 .901 ,95% CI：1 .373 -2 .633 , P=0 .000） and for MACE in a 3-month follow-up period （OR=1 .040 ,95% CI：1 .008 -1 .074 , P=0 .015;OR=1 .543 ,95% CI：1 .170-2 .034 ,P=0 .002） .PCI was a protective factor for MACE in a 3-month follow-up period （OR=0 .090 ,95% CI：0 .026-0 .306 ,P=0 .000） .Conclusion The age of female AMI patients is older and their heart function is poorer with a higher risk of MACE and a less chance for PCI .However ,gender itself is not an independent predictor for in hospital mortality and M ACE in a 3-month follow-up period .