不同性别急性心肌梗死患者临床比较分析

目的：分析急性心肌梗死（AMI）男、女患者住院病死率的差异及其影响因素。方法：回顾性分析1034例AMI患者（男718例，女316例）的临床资料，对其临床特征、诊疗情况及住院病死率进行比较分析。结果：女性患者的发病年龄高于男性[（70．1±8．8）岁vs（62．3±12．1）岁，P〈0．001]，高血压史、糖尿病史、心绞痛史阳性率均高于男性，Killip分级≥Ⅲ级患者比例高于男性（20．4％VS11．3％，P〈0．001）。所有女性AMI患者和女性ST段抬高型心肌梗死（STEMI）患者的住院病死率均显著高于男性（15．5％VS5．7％，P〈0．001；16．1％VS5．7％，P〈0．001），住院期间接受β受体阻滞剂和单纯介入治疗的比例低（64．6％VS73．4％，P〈0．05；16．5％VS32．0％，P〈0．001）。对所有住院AMI患者住院病死率的影响因素进行多变量Logistic回归分析显示：女性、年龄I〉70岁、心绞痛史、吸烟史、Killip分级≥Ⅲ级是独立危险因素，急诊PCI是独立保护性因素（校正后OR=0．323；95％CI：0．123～0．852）。结论：女性AMI患者心功能差，接受β受体阻滞剂和单纯介入治疗的比例均低于男性，且所有女性AMI患者和女性STEMI患者的住院病死率均高于男性。

Sex differences in treatment and in-hospital mortality after acute myocardial infarction

Objective： To analyze gender differences of in-hospital mortality and related risk factors in patients with AMI. Methods： A retrospective of study was carried out in 1 034 patients with AMI （male, 718; female, 316）. Results： The female patients with AMI were older than male patients [（70.1 ± 8.8） years vs （62.3 ± 12.1） years, P〈0.001]. They had higher prevalence of hypertension, diabetes, angina and Killip＇s grade ≥Ⅲ rank （20.4% vs 11.3%, P〈0.001）. In-hospital mortality rates of female patients with AMI and ST segment elevation myocardial infarction （STEMI） were higher than male patients （15.5% vs 5.7%, P〈0.001; 16.1% vs 5.7%, P〈0.001）. And they were less likely to receive β-blocker and primary PCI than male patients （64.6% vs 73.4%, P〈0.05; 16.5% vs 32.0%, P〈0.001）. Muhivariable Logistic regression analysis of all AMI patients showed that female, age ≥ 70 years, the history of angina and smoking, Killip＇ s grade ≥Ⅲ rank were independent risk factors. Emergency PCI was independent protective factor （adjusted OR=0.323; 95%CI, 0. 123-0.852）. Conclusion： Female patients＇ cardiac functions are worse. They are less likely to receive β-blocker and interventional therapies. In-hospital mortality rates of female patients with AMI and STEMI are both higher than male patients.