女性首次非ST段抬高型心肌梗死的临床特征及PCI后预后因素分析

Clinical characteristics and prognostic factors after percutaneous coronary intervention of women with the first non-ST-segment elevation myocardial infarction

目的探讨女性首次非ST段抬高型急性心肌梗死(NSTEMI)患者的临床特征及经皮冠状动脉介入治疗(PCI)的预后影响因素。方法选取2013年6月至2015年6月发病24 h内行PCI的急性心肌梗死(AMI)女性患者123例,其中NSTEMI患者70例,ST段抬高型心肌梗死(STEMI)患者53例,比较NSTEMI与STEMI患者的临床资料,同时采用Cox回归模型分析影响女性NSTEMI患者预后的相关因素。结果 NSTEMI、STEMI患者中高血压分别为48、26例,糖尿病分别为38、38例,高脂血症分别为52、29例,收缩压分别为(134.31±22.26)、(125.04±19.63)mm Hg,白细胞计数分别为(9.02±3.75)、(11.37±3.63)×109/L,肌钙蛋白-I分别为(8.63±18.34)、(18.79±27.76)μg/L,两者比较,均P<0.05。出院后1年期间内,NSTEMI患者血运重建率、发生主要心血管不良事件率均高于STEMI患者(47.7%vs.28.0%,62.9%vs.35.8%),均P<0.05)。Cox生存分析显示,白细胞计数(HR=1.241)、肌钙蛋白-I(HR=1.026)升高是女性首次NSTEMI患者PCI预后的危险因素。结论与女性STEMI患者相比,女性NSTEMI患者合并高血压、糖尿病、高脂血症更多,收缩压更高,白细胞计数、肌钙蛋白-I更低。女性NSTEMI患者远期预后较差,白细胞计数、肌钙蛋白-I升高是女性首次NSTEMI患者PCI预后的危险因素。

Objective To investigate the clinical characteristics and prognostic factors after percutaneous coronary intervention of women with the first non-ST-segment elevation myocardial infarction. Methods A total of 123 female patients with AMI, including 70 patients with NSTEMI and 53 patients with ST-segment elevation myo- cardial infarction （STEMI）, who received PCI within 24 hours of onset were selected from June 2013 to June 2015. The clinical data were compared between patients with NSTEMI and with STEMI. Cox regression model was used to analyze the prognostic factors for the elderly patients with NSTEMI. Results The female patients with NSTEMI had more cases of patients with hypertension （48 vs. 26） , diabetes （38 vs. 38） and hyperlipidemia （52 vs. 29） than the female patients with STEMI. Significant differences in systolic blood pressure [ （134.31±22.26）mmHg vs. （125.04±19.63 ）mmHg], levels of white blood cell [ （9.02 ± 3.75）109/L vs. （11.37 ±3.63 ）109/L] and troponin I [ （ 8.63 ±18.34 ） μg/L vs. （ 18.79 ± 27.76） μg/L ] were observed in the above two groups （1 P 〈 0.05, respectively ）. The rates of revascularization, major adverse cardiovascular events in NSTEMI group were higher than those in STEMI group during 1 year after discharge （47.7% vs. 28.0%, 62.9% vs. 35.8% ） （P 〈 0.05, respectively）. Cox survival analysis showed that white blood cell （HR = 1.241 ） and troponin-I （HR = 1.026） elevation were the risk prognostic factors after PCI for women with the first NSTEMI. Conclusion More hypertension, diabetes, hyper- lipidemia and higher levels of systolic blood pressure, lower levels of white blood cell and troponin I were observed in women with the first NSTEMI. The long-term prognosis of female patients with NSTEMI is poor. And elevated lev- els of white blood cell and troponin -I were the risk prognostic factors after PCI for women with the first NSTEMI.