不同性别急性心梗患者的临床特征及院内治疗预后分析

Clinical Features, Treatments and Short-term Outcome of Male and Female Patients with Initial Acute Myocardial Infarction

目的:观察首次确诊为急性心肌梗死(AMI)患者的临床特征并分析不同性别人群的在入院治疗及院内短期预后的差异。方法:回顾性分析2010年2月至2012年4月在沈阳军区总医院心内科初次确诊为AMI的患者271例,并按性别分为两组,其中男性组180例,女性组91例,统计其临床特征、入院后的药物和手术治疗情况,以及院内并发症及预后情况,分析总结两组患者各自的特点和差异。结果:女性患者的年龄要大于男性患者(63±14vs71±11,P<0.001),且同时更易患有高血压等心血管疾病合并症(73.3%vs 58.2%,P<0.05)。女性患者的发病至入院治疗时间长于男性(P<0.001),且入院后行PCI治疗的比例要明显低于男性患者(67%vs 79.4%,P<0.05)。初步分析结果表明,女性患者的院内死亡率高于男性(11%vs 3.3%,OR:3.11,95%CI:1.53-7.15),但排除不均衡因素的影响后,男女患者的院内死亡率无明显差异(OR:2.11,95%CI:0.68-5.12)。结论:两性AMI患者的临床特征、入院后治疗及院内短期预后均存在一定差异。根据女性患者的临床特征和院内治疗及预后的现状,应进一步加强对女性高危人群的冠心病诊治知识普及和教育,且对入院后的女性患者应采取更为积极的药物和介入手术治疗手段,以改善预后。

Objective： To evaluate the gender differences in clinical features, hospital treatments, in-hospital complications and outcomes of patients with an initial acute myocardial infarction（AMI）. Methods： Retrospective analysis was carried out in 271 patients with initial AMI, including 180 male and 91 female. The clinical data of clinical features, hospital treatment, in-hospital complications and outcome were then compared between the two groups. Results： The female patients were older（63±14 vs 71±11, P0.001） and were more likely than the male patients to have had previously diagnosed comorbidities, such as hypertension（73.3% vs 58.2%, P0.05）.And the female patients were more likely to have delayed seeking medical care after the onset of AMI than male patients（P0.001）. In addition, during hospitalization, female were less likely to have undergone percutaneous coronary intervention（PCI） compared with male（67% vs 79.4 %, P0.05）. The results of preliminary analysis indicated that female patients experienced higher in-hospital mortality than male（11 % vs 3.3 %, OR：3.11, 95 %CI： 1.53-7.15）. However, the differences were decreased after adjustment for imbalance factors（OR： 2.11, 95 %CI： 0.68-5.12）. Conclusions： The clinical features, hospital treatments, in-hospital complications and outcomes were different between male and female patients with initial AMI. The targeted and timely healthy education for female high-risk population of coronary heart disease should be further strengthened. And more aggressive treatments for female AMI patients should be taken to improve the prognosis.