性别差异对高龄冠心病患者经皮冠状动脉介入治疗预后的影响

Influence of sex difference on the therapeutic prognosis in aged patients with coronary heart disease receiving percutaneous coronary intervention

目的探讨性别差异对接受经皮冠状动脉介入治疗(PCI)的高龄冠心病患者预后的影响。方法回顾性分析2015年1月至2015年12月接受PCI治疗的451例年龄≥75岁冠心病患者,其中男259例(男性组),女192例(女性组)。比较两组住院和随访期临床基本资料、PCI情况及主要心脑血管不良事件(MACCE)发生率。结果男性组高血压病比例低于女性组(71.0%对84.4%,P<0.05),吸烟史(44.8%对3.6%)、慢性肾功能不全(11.2%对4.7%),C型病变(47.5%对33.9%)、左主干病变(11.2%对5.7%)及Syntax评分(18.94±12.94对15.88±9.99)均高于女性组(P<0.05)。两组住院期和术后1、6、12个月MACCE发生率、全因病死率差异无统计学意义(P>0.05),住院期与术后1、6、12、18个月心血管病死率差异无统计学意义(P>0.05)。男性组术后18个月MACCE发生率(22.7%对12.6%)、全因病死率(15.6%对7.1%)显著高于女性组(P<0.01)。多元logistic回归分析显示,性别是高龄冠心病患者PCI术后18个月内发生MACCE的独立危险因素。结论性别是高龄冠心病患者PCI术后发生MACCE的独立危险因素。

Objective To investigate the influence of sex difference on the prognosis of aged patients with coronary heart disease（CHD） who receive percutaneous coronary intervention（PCI）. Methods The clinical data of a total of 451 aged patients（≥75 years old）, who underwent PCI during the period from January 2015 to December 2015 at authors′ hospital, were retrospectively analyzed. The patients included259 males（male group） and 192 females（female group）. The basic clinical data, PCI-related complications,and the incidence of major adverse cardiovascular and cerebrovascular events（MACCE） were documented,and the results were compared between the two groups. Results The proportion of patients suffering from hypertension in the male group was lower than that in the female group（71.0% vs 84.4%, P〈0.05）.Comparison between male group and female group, smoking history was 44.8% vs 3.6%, chronic renal insufficiency was 11.2% vs 4.7%, lesion of type C was 47.5% vs 33.9%, left main coronary artery disease was 11.2% vs 5.7%, and the Syntax score was（18.94±12.94） vs（15.88±9.99）. The percentage values of all the above indexes in the male group were significantly higher than those in the female group（P〉0.05 in all）.No statistically significant differences in the incidences of MACCE and all-cause mortality during the stage of hospitalization and at one, 6, 12 months after PCI existed between the two groups（P〉0.05 in all）. No statistically significant difference in the cardiovascular death rate during the stage of hospitalization and at one, 6, 12, 18 months after PCI existed between the two groups（P〈0.05）. Eighteen months after PCI, the incidences of MACCE and all-cause mortality in the male group were 22.7% and 15.6% respectively, which were remarkably higher than those in the female group（12.6% and 7.1% respectively）, and the differences were statistically significant（P〈0.01）. Multivariate logistic regression analysis showed that sex was an independent risk factor for the occurrence of MACCE in aged CHD patients within 18 months after receiving PCI. Conclusion The results of this study indicate that sex is an independent risk factor for the occurrence of MACCE in aged CHD patients after receiving PCI.