性别对80岁以上高龄急性冠脉综合征患者长期预后的影响

Influence of gender on long-term prognosis of acute coronary syndrome in over-80-year-old patients

目的 探讨性别对≥80岁高龄急性冠脉综合征（ACS）患者长期预后的影响。方法 连续入选解放军总医院心内科自2006年1月至2011年12月≥80岁行冠状动脉造影检查的ACS患者664例（女性占28.31%）。根据性别进行分组，对两组患者的临床资料结果进行比较分析，记录患者主要不良心脏事件（MACE），Kaplan-Meier生存曲线分析性别对高龄ACS患者长期生存率的影响。Cox多因素回归分析影响长期预后的独立危险因素。结果 随访周期13～79个月（中位数28个月）。女性患者高脂血症患病率、左室射血分数、体质量指数及空腹血糖水平高于男性患者（P＜0.05）。男性患者舒张压、血尿酸水平、吸烟史、慢性肾功能不全、陈旧性心肌梗死、脑卒中发病率高于女性患者（P＜0.05）。两组患者的ACS临床分型、用药方案及治疗策略未见显著差异（P＞0.05）。Kaplan-Meier 生存曲线分析显示， 两组患者长期生存率（P＝0.619）及无事件生存率（P＝0.365）均无显著差异。Cox多因素回归分析显示非高密度脂蛋白胆固醇（non-HDL-C）、收缩压水平是高龄ACS患者全因死亡（HR=1.73，95%CI：1.09～2.75，P=0.019；HR=0.98，95%CI：0.97～1.00，P=0.015）和MACE发生（HR=1.80，95%CI：1.22～2.63，P=0.003；HR＝0.98，95%CI：0.97～0.99，P=0.003）的独立危险因素。结论 性别不是影响高龄ACS患者长期预后的危险因素，non-HDL-C和收缩压水平是该人群的全因死亡和MACE发生的独立危险因素。

Objective To investigate the effect of gender on the long-term prognosis in the elderly acute coronary syndrome （ACS） patients over 80 years old. Methods All 664 consecutive ACS octogenarians （28.31% women） admitted and undergoing coronary angiography in our department from January 2006 to December 2011 were enrolled in this study. They were assigned into male and female groups. Clinical data were collected and compared between the 2 groups. The occurrence of major adverse cardiac events （MACE） was recorded. Kaplan-Meier survival analysis was performed for the effect of gender on long-term survival in the cohort. Cox multivariate regression analysis was carried out to study the independent predictors for long-term prognosis. Results The follow-up period ranged from 13 to 79 months （median 28 months）. The women had higher hyperlipidemia incidence, larger left ventricular ejection fraction, higher body mass index, and elevated fasting blood glucose than the men （P〈0.05）. But diastolic blood pressure, serum uric acid, percentages of smoking history and previous myocardial infarction, and incidences of stroke and chronic renal failure were higher in the male than in the female groups （P〈0.05）. There were no significant differences in clinical classification of ACS, medicine and treatment strategies between the 2 groups （P〉0.05）. Kaplan-Meier survival analysis showed that no significant differences were observed in long-term survival （P=0.619） and event-free survival （P=0.365） between the 2 groups. Cox multivariate regression analysis revealed that non-high density lipoprotein cholesterol （non-HDL-C） and systolic blood pressure level were independent predictors for long-term all-cause mortality （HR=1.73, 95%CI： 1.09-2.75, P=0.019; HR=0.98, 95%CI： 0.97-1.00, P=0.015） and MACE （HR=1.80, 95%CI： 1.22-2.63, P=0.003; HR=0.98, 95%CI： 0.97-0.99, P=0.003）. ConclusionGender is not a risk factor for long-term prognosis in ACS octogenarians, but non-HDL-C and systolic blood pressure are independent predictors for long-term all-cause mortality and MACE.