女性ST段抬高型心肌梗死合并多支血管病变行直接经皮冠脉介入术预后分析

Prognosis analysis of female patients with ST-segment elevation myocardial infarction complicated with multivessel disease after primary angioplasty

目的观察女性ST段抬高型心肌梗死(ST-segment elevation myocardial infarction, STEMI)合并多支病变(multivessel disease, MVD)行直接经皮冠状动脉介入术(percutaneous coronary intervention, PCI)患者的临床特征, 并探究影响女性预后的因素。方法本研究为回顾性队列研究, 入选2005-2015年以STEMI合并MVD就诊于本院并且在症状发作24 h内成功完成直接PCI的患者1 033例, 其中女性196例。收集患者基线、PCI术资料, 随访采取集中电话和病例随访。通过Kaplan-Meier法绘制生存曲线。利用Cox回归模型筛选不同性别STEMI多支病变患者影响预后的因素。结果与男性患者相比, 女性发病年龄显著较高, 而吸烟史、冠心病家族史、支架植入史的比例显著较低, 其发病到行PCI术的时间显著延长, 术中发生慢血流/无复流的比例显著较高。平均随访时间为4年, 女性的主要心血管不良事件发生率始终高于男性。影响女性患者预后的主要因素为Killip心功能分级Ⅱ~Ⅳ级(HR=1.804, 95%CI 1.060~3.071,P<0.05);而狭窄程度超过50%的病变数(HR=1.808, 95%CI:1.123~2.912,P<0.01), 为男女共同的危险因素。结论与男性相比, STEMI合并MVD行直接PCI的女性患者, 救治延迟显著, 主要心血管不良事件发生率较高, 心功能不全是影响女性患者不良预后的主要因素。

Objective To observe the clinical characteristics of female patients with ST-segment elevation myocardial infarction(STEMI)complicated with multivessel disease(MVD)undergoing direct percutaneous coronary intervention(PCI),and to explore the factors affecting the prognosis of female patients.Methods In this retrospective cohort study.1033 patients(196 women)with STEMI combined with MVD who were admitted to our hospital from 2005 to 2015 and successful completed direct PCI within 24 h onset of symptom were enrolled.Patients'baseline data,PCI data and follow-up results were recorded.Kaplan-Meier method was used to plot the survival curve.Cox regression model was used to screen the prognostic factors of STEMI patients with multivessel disease.Results Compared with male patients,the age of female patients was significantly older,while the proportion of smoking history,family history of coronary heart disease,and stent implantation history was significantly lower,the time from onset to PCI was significantly longer,and the proportion of intraoperative slow blood flow/no-reflow was significantly higher among female patients.The mean follow-up time was 4 years,and the incidence of major adverse cardiovascular events(MACE)was higher in women than in men.The main factor afecting the prognosis of female patients was Killip cardiac function grade Ⅱ-Ⅳ(HR=1.804,95%CI:1.060-3.071,P<0.05).The number of lesions with>50%occlusion(HR=1.808.95%CI 1.123-2.912,P<0.01)was a common risk facor for both men and women.Conclusions Compared with male patients,there is more treatment delay among female patients with STEMI and MVD,the incidence of MACE is higher,and cardiasc insuficiency is the main factor ffecting the prognosis of female patients.