不同性别STEMI患者临床特征和治疗方案差异及住院期间预后不良的危险因素分析

Differences in clinical features and treatment plans and analysis of risk factors for poor prognosis during hospitalization in STEMI patients with different genders

目的探讨不同性别急性ST段抬高心肌梗死(STEMI)患者临床特征和治疗方案差异,并分析STEMI患者住院期间预后不良的危险因素。方法选择STEMI患者1 120例,男661例、女459例,收集患者临床资料并追踪临床结局。分析不同性别STEMI患者临床特征和治疗方案差异。采用多因素Logistic回归模型分析影响STEMI患者住院期间预后不良的危险因素。结果女性STEMI患者年龄,合并高脂血症、高同型半胱氨酸血症例数,多支冠脉病变比例、冠脉狭窄率、Gensini评分,PCI后TIMI心肌灌注(TMPG)分级0、1级比例,以及全因死亡和主要不良心血管事件(MACE)例数均高于男性(P均<0.05)。多因素Logistic回归分析显示,女性、高同型半胱氨酸血症及PCI后TMPG分级0、1级是STEMI患者住院期间预后不良的危险因素(P均<0.01)。结论女性STEMI患者年龄更大,高脂血症、高同型半胱氨酸血症并发率更高,冠脉病变程度更重,PCI后更易发生心肌灌注不良,预后更差;女性、高同型半胱氨酸血症及PCI后TMPG分级0、1级是STEMI患者住院期间预后不良的危险因素。

Objective To investigate the differences of clinical features and treatment options in different gender pa⁃tients with acute ST segment elevation myocardial infarction(STEMI),and to analyze the risk factors for poor prognosis in pa⁃tients with STEMI during hospitalization.Methods Totally 1120 patients with STEMI were selected,including 661 males and 459 females.Their clinical data were collected and clinical outcomes were followed up.The differences of clinical fea⁃tures and treatment options of STEMI patients of different genders were analyzed.Multivariate Logistic regression model was used to analyze the risk factors for poor prognosis during hospitalization in patients with STEMI.Results Age,the number of diabetes,hyperhomocysteinemia,the proportion of multiple coronary artery disease,coronary stenosis rate,Gensini score,the proportion of TIMI myocardial perfusion(TMPG)grade 0 and 1 after PCI,and the number of all-cause deaths and major adverse cardiovascular events(MACE)were higher in females than in males(all P<0.05).Multivariate Logistic regression analysis showed that female,hyperhomocysteinemia,and TMPG grade 0 and 1 after PCI were risk fac⁃tors for poor prognosis of STEMI patients during hospitalization(all P<0.01).Conclusion Female STEMI patients are older,have a higher complication rate of hyperlipidemia and hyperhomocysteinemia,have more severe coronary lesions,are more likely to have poor myocardial perfusion,and have a worse prognosis after PCI;female,hyperhomocysteinemia,and TMPG grade 0 and 1 after PCI are risk factors for poor prognosis of STEMI patients during hospitalization.