老年女性急性ST段抬高型心肌梗死患者临床特征分析

Clinical characteristics of elderly female acute ST-segment elevation myocardial infarction patients

目的探讨老年女性急性ST段抬高型心肌梗死(STEMI)患者的临床特征。方法回顾性分析2015年11月~2017年2月我院心血管内科连续收入的老年STEMI患者108例,根据患者性别分为男性组63例和女性组45例。比较2组患者的临床基线资料、PCI及院内预后情况。结果与男性组比较,女性组发病年龄显著升高[(75.13±7.27)岁vs(69.81±9.16)岁,P<0.01],肾小球滤过率显著降低[(62.39±27.34)ml/(min·1.73m2)vs(77.37±26.36)ml/(min·1.73m2),P<0.05)]。女性组典型胸痛比例、LVEF显著低于男性组,而B型钠尿肽、左心室舒张末内径、CRUSADE评分显著高于男性组,差异有统计学意义(P<0.01)。与男性组比较,女性组3支病变比例更高(69.2%vs 35.0%,P<0.01),支架直径偏细[(2.81±0.28)mmvs(2.97±0.29)mm,P<0.05];而再灌注治疗后,女性组平均住院天数更长,心肌梗死后心绞痛、反复发作心力衰竭比例显著升高[(10.60±3.61)d vs(7.67±2.44)d,P<0.01;15.6%vs 3.2%,P<0.05;26.7%vs 3.2%,P<0.01]。结论老年女性STEMI患者年龄偏大,临床症状不典型,病变较重,心功能更差,心肌梗死后并发症增多,且出血风险增高。

Objective To study the clinical characteristics of elderly female acute ST-segment ele- vation myocardial infarction （STEMI） patients. Methods One hundred and eight ≥60 years old acute STEMI patients admitted to our hospital from November 2015 to February 2017 were divid- ed into male group （n=68） and female group （n=45）. Their clinical baseline data,coronary artery intervention and outcome in hospital were compared between the two groups. Results The age of disease onset was significantly older and the eGFR was significantly lower in female group than in male group （P〈0.05,P〈0.01）. The incidence of typical chest pain and the LVEF were signifi- cantly lower while the serum NT-proNBP level was significantly higher,the left ventricular end diastolic pressure diameter was significantly longer and the CRUSADE score was significantly lower in female group than in male group （P〈0.01）. The incidence of 3-blood vessel lesion was significantly higher, the diameter of implanted stents was significantly shorter in female group than in male group （P〈0.05）. However, the hospital stay time was significantly longer and the incidence of angina pectoris and recurrent heart failure after myocardial infarction was significant- ly higher in female group than in male group following reperfusion therapy （P〈0.05 ,P〈0.01）. Conclusion The clinical symptoms are more atypical, the lesion is severer, the heart function is poorer, the incidence of complications after myocardial infarction is higher, and the risk of bleeding is greater in elderly female STEMI patients than in elderly male STEMI patients.