75岁以上急性冠状动脉综合征患者介入治疗性别对比研究

目的探讨75岁及以上老年急性冠状动脉综合征患者介入治疗的临床特点及近期疗效的性别差异。方法选择75岁及以上老年急性冠状动脉综合征患者307例,男181例,女126例,统计临床特点、冠状动脉病变支数及部位、手术成功率和住院病死率。结果急性冠状动脉综合征3种临床类型分布在男性与女性差异无统计学意义,以不稳定性心绞痛和ST段抬高心肌梗死为主。男性血运重建史明显多于女性(18.8%υs 5.6%,P=0.001);女性原发性高血压明显多于男性(74.6%υs 61.3%,P=0.015),血脂异常明显多于男性(62.7%υs 46.4%,P=0.005)。冠状动脉造影男性与女性均以3支病变为主(63.0%υs 70.6%,P=0.1 60),男性双支病变明显多于女性(29.3%υs 17.5%,P=0.018)。手术成功率和院内病死率差异无统计学意义(P>0.05)。ST段抬高心肌梗死logistic回归分析显示,心源性休克、病变血管部位(左前降支)、年龄、血糖是老年患者住院死亡的独立预测因素。结论老年女性高血压和血脂异常多于男性;冠状动脉病变均以3支病变为主,男性双支病变多于女性;急性冠状动脉综合征临床类型和PCI的近期疗效无性别差异。

Comparison of intervention therapy for acute coronary syndrome patients aged 75 and over between men and women

Objective To evaluate the gender difference in elderly patients with acute coronary syndrome (ACS) in clinical characteristics,coronary features and in-hospital outcome.Methods Data were retrospectively collected from 307 patients including 181 men and 126 women with diagnosis of ACS.Clinical characteristics,coronary artery lesion,success rate of PCI and in-hospital mortality were compared.Results There were no gender difference in types of ACS.Elderly man had more histories of early revascularization(18.8%vs 5.6%,P = 0.001),elderly women had a higher incidence of hypertension and dyslipidemia(62.7%vs 46.4%,P = 0.005 and 74.6%vs 61.3%, P = 0.015).Incidence of three-vessel lesion was similar in two groups(63.0%vs 70.6%,P = 0.160) incidence of double-lesion was higher in men than women(29.3%vs 17.5%,P = 0.018). There were no difference in success rate of intervention and in-hospital mortality between elderly men and women.Binary logistic regression analysis in patients with acute ST-elevated myocardial infarction demonstrated that cadiogenic shock,LAD infarction,age and blood glucose correlated with in-hospital mortality(P<0.05).Conclusions Elderly women had a higher incidence of hypertension and dyslipidemia than men,Three-vessel lesion was the most common lesion in both groups,and elderly men had a higher incidence of double-lesion than women.There were no gender difference in types of ACS and in-hospital mortality rate.