老年女性急性心肌梗死的临床特征和预后

Clinical characteristics and prognosis of elderly female with acute myocardial infarction

目的探讨老年女性发生急性ST段抬高型心肌梗死(STEMI)的临床特点及预后。方法回顾性分析2013年1月至2018年5月诊断为STEMI的老年(61～80岁)女性患者239例为病例组,选取同期住院的年轻(年龄<50岁)的STE-MI女性患者141例作为对照组。比较两组入院时心率、血压、血红蛋白、生化、肌钙蛋白等基本情况及高血压、2型糖尿病、血脂异常、吸烟史、冠心病家族史等危险因素;比较两组梗死相关冠状动脉病变部位及在院期间主要不良心脏事件(MACE)的发生率。结果 (1)与年轻女性对照组比较,老年女性STEMI合并高血压较多;高密度脂蛋白胆固醇水平较低;肌钙蛋白水平较高,差异均有统计学意义(P<0.05)。(2)与年轻女性对照组比较,老年女性冠状动脉造影结果提示三支病变比例较高,而单支病变比例较低,差异有统计学意义(P<0.05);梗死相关冠状动脉累及右冠状动脉比例较高(P<0.05)。(3)老年女性在院期间MACE的发生率与对照组比较明显升高,差异有统计学意义(P<0.05),其中急性心功能不全、死亡的发生率较高(P<0.05)。结论与年轻女性STEMI组比较,老年女性STEMI组合并高血压较多,冠状动脉病变严重,在院期间更易发生急性心功能不全,甚至死亡,预后不佳。

Objective To investigate clinical characteristics and prognosis of elderly female with ST-segment elevation acute myocardial infarction(STEMI).Methods Clinical characteristics and prognosis were compared among 239 elderly female with STEMI and 141 young female,all patients were admitted to hospital and underwent coronary angiography.Heart rate,blood pressure,hemoglobin(Hb),biochemical test,troponin,essential hypertension,type 2 diabetes mellitus,dyslipidemia,smoking history,familial history of coronary artery disease were measured.Coronary angiographic characteristics were observed by coronary angiography.Results Prevalence of essential hypertension was higher in elder female group with STEMI than that in young female control group with STEMI(P<0.05).Level of high-density lipoprotein cholesterol was lower and level of troponin was higher in elder female group with STEMI than those of young female control group with STEMI(P<0.05).Compared with the control group of young female,the results of coronary angiography in elderly female group showed a higher proportion of three-branch lesions and a lower proportion of single-branch lesions(P<0.05).Coronary artery disease mainly involved right coronary artery(P<0.05).The total ratio of major adverse cardiac events(MACE)during hospital was higher in elderly female group than that of young female control group.Mortality and ratio of acute heart failure was also higher in elderly female group.Conclusions Compared with the young female,the elderly female has higher prevalence of essential hypertension.Coronary artery disease is more serious.And elderly female is more likely to suffer from acute cardiac insufficiency,death and has poor prognosis during hospitalization.