不同性别急性冠状动脉综合征患者临床特征及预后影响因素分析

Clinical characteristics and prognosis of patients with acute coronary syndrome undergone percutaneous coronary intervention in different gender

目的探讨不同性别急性冠状动脉综合征(ACS)患者的临床特征及影响预后的因素。方法连续入选2014年1月至2015年10月承德医学院附属医院心脏内科行经皮冠状动脉介入治疗并符合纳入标准的ACS患者845例,其中女207例(女性组),男638例(男性组),收集患者的基线资料及所有临床资料,建立冠状动脉造影数据库,规律随访,进行预后分析。结果两组患者主要不良心血管事件及全因死亡率比较,差异均无统计学意义(均P>0.05)。女性组患者年龄[(60.3±9.8)岁比(55.8±10.3)岁,P<0.001]、发病到首次就诊时间[365(14,460)d比60(5,1095)d,P<0.001]、疾病加重到就诊时间[168(24,360)h比96(9,360)h,P=0.007]、高血压病(70.0%比52.5%,P<0.001)、血脂异常(63.3%比53.4%,P=0.013)、2型糖尿病(32.4%比21.2%,P<0.001)比例等显著高于男性组,差异均有统计学意义。多因素Cox风险回归模型显示,因心脏事件再入院、入院48 h内室性心动过速(室速)或心室颤动(室颤)、入院时白细胞升高、B型脑利钠肽>100 pg/ml、左心室肥厚均为影响ACS患者预后的独立危险因素,其HR值分别为4.590、4.174、2.861、2.199、3.503(均P<0.05)。结论女性ACS患者较男性初始患病年龄大,就诊延迟更为明显,合并高血压病、血脂异常、2型糖尿病等代谢性危险因素患病率高,但女性与男性患者远期预后差异无统计学意义。

Objective To compare the clinical and prognostic risk factors of the patients with acute coronary syndrome（ ACS） of different genders. Methods We consecutively enrolled 207 women and 638 men with ACS who received PCI from January 2014 to October 2015 in our hospital. The clinical and angiographic data of the patients were collected and followed up for two years by physicians in the department of cardiology. Results Female patients were found to have higher age than male patients in this study[（ 60. 32 ± 9. 8） years old vs.（ 56 ± 10） years old,P 〈 0. 001],and the median time from the onset to exacerbation of ACS（ 365 days vs. 60 days） and to the first medicine contact of female patients were significantly later than male（ 168 hours vs. 90 hours）（ all P 〈 0. 001）,respectively. The co-morbidities of hypertension（ 70% vs. 52. 5%）,dyslipidemia（ 63. 3% vs. 53. 4%）, and type 2 diabetes mellitus（ 32. 4% vs. 21. 2%） were significantly higher in female ACS patients than those in male（ all P 〈 0. 05）.There was no significant difference in all-cause death and the major adverse cardiac events（ MACE） between the 2 gender（ P 〉 0. 05）. Multivariate Cox regression study showed that the readmissions for cardiac events,ventricular tachycardia/fibrillation within 48 hours of hospitalization,elevation of white blood cell count,increase in BNP levels and left ventricular hypertrophy were all independent prognostic factors of ACS. There was no difference in the risk of MACE between different gender patients with ACS. Conclusions Female patients with ACS undergone PCI were older,had much longer delay from the onset and exacerbation of ACS to the first medicine contact than male. Higher co-morbidities of hypertension,dyslipidemia and type 2diabetes mellitus were found in female than male. No sex differences were found in long term prognosis of patients with acute coronary syndrome undergone percutaneous coronary intervention in this study.