女性急性ST段抬高型心肌梗死患者的临床特点

Clinical characteristics of acute ST elevation myocardial infarction in women

目的探讨女性急性ST段抬高型心肌梗死患者的临床特点。方法选取2014年9月至2016年12月首都医科大学附属北京天坛医院心血管内科诊断为急性ST段抬高型心肌梗死并行急诊冠状动脉造影的患者452例,按性别分为两组,女性组102例,男性组350例。回顾性分析患者一般临床资料、冠状动脉造影、实验室检查、心脏功能和结构及住院期间病死率。结果与男性组相比,女性组发病年龄大[(66.4±10.6)岁比(58.4±11.1)岁,P<0.001],就诊时间晚[(4.6±4.9)h比(2.6±1.9)h,P<0.001],GRACE评分高(206.5±45.1比186.7±50.5,P<0.001)。此外,女性单支血管病变比例低(14.7%比32.6%,P=0.037),术后发生慢血流及使用IABP比例高(11.8%比4.6%,P=0.008;11.8%比5.4%,P=0.026)。女性组的肌酸激酶同工酶MB、高敏肌钙蛋白I和B型利钠肽峰值均显著高于男性组,超声心动图显示左心室射血分数显著低于男性组(53.9%±10.3%比57.9%±8.2%,P<0.001)。女性组的住院期间病死率显著高于男性组(7.8%比2.3%,P=0.013)。结论女性急性ST段抬高型心肌梗死患者发病年龄大,就诊时间晚,冠状动脉造影显示病变重,血管开通后发生慢血流比例高,术后心功能差,住院病死率高。

Objective To analyze the clinical features of acute ST elevation myocardial infarction（ MI） in female patients. Methods A total of 452 patients with acute ST elevation myocardial infarction（ STEMI） underwent emergency coronary angiography were retrospectively enrolled in this study in Beijing Tian Tan Hospital,Capital Medical University from September 2014 to December 2016. All patients were divided into two groups based on gender,with 102 patients in female group and 350 patients in male group. Clinical data,coronary angiography results,laboratory tests,parameters of cardiac structure and function and in-hospital mortality were collected and analyzed. Results Compared with male group,onset age was significantly older in female group [（ 66. 4 ± 10. 6） yrs vs.（ 58. 4 ± 11. 1） yrs,P〈0. 001 ],time to visiting doctor was longer [（ 4. 6 ± 4. 9） h vs.（ 2. 6 ± 1. 9） h,P〈0. 001],and the GRACE score was higher（ 206. 5 ± 45. 1 vs. 186. 7 ± 50. 5,P〈0. 001）. Meanwhile,single vessel lesion in female was significantly fewer（ 14. 7% vs. 32. 6%,P = 0. 037）,while incidence of postoperative slow flow and IABP use was higher（ 11. 8% vs. 4. 6%,P = 0. 008,11. 8% vs. 5. 4%,P = 0. 026）. In addition,the peak of creatine kinase-MB,high sensitivity cardiac troponin I and B-type natriuretic peptide were significantly higher in females than those in male,while left ventricular ejection fraction was significantly lower in female than that in male（ 53. 9% ± 10. 3% vs. 57. 9% ± 8. 2%,P〈0. 001）. In-hospital mortality was significantly higher in the female group than male group（ 7. 8% vs. 2. 3%,P = 0. 013）. Conclusions Female with acute STEMI were usually older,longer time to visit,severer coronary lesions,higher incidence of slow blood flow,poor cardiac function and higher risk of in-hospital mortality.