影响急性ST段抬高心肌梗死住院病死率性别间差异的因素分析

目的:调查急性ST段抬高心肌梗死(STEMI)住院病死率性别间有无显著差异及其影响因素。方法:分析1993年～2006年我院心内科首次发作且发病24 h内入院的1 278例急性STEMI患者的临床资料。结果:女性患者年龄、并发高血压病、糖尿病、入院空腹血糖、总胆固醇、低密度脂蛋白胆固醇显著高于男性,女性患者无发病诱因、症状不典型者多,发病至就诊时间延长,且住院期间接受血管紧张素转换酶抑制剂(ACEI)、β-受体阻滞剂、他汀类药物以及冠脉介入治疗(PCI)的比例低于男性;Logistic回归分析显示,女性患者住院病死率显著高于男性的影响因素是年龄较大、并发高血压病、入院空腹血糖较高且较少接受ACEI、β-受体阻滞剂以及PCI治疗。结论:急性STEMI患者女性住院病死率较男性高,与其并发较多危险因素且未接受更积极的治疗有关。

Analysis of in-hospital mortality difference between male and female patients with acute ST-segment elevation myocardial infarction

AIM: To analyze the in-hospital mortality difference between male and female patients with acute ST-segment elevation myocardial infarction (STEMI). METHODS: A retrospective analysis of clinical data was conducted in 1 278 patients with first STEMI who were admitted to our institution within 24 h of symptom onset. RESULTS: Compared with males, females were older and had a higher incidence of hypertension and diabetes mellitus and higher levels of fasting plasma glucose, total cholesterol and low-density lipoprotein cholesterol. Fewer women took angiotensin-converting enzyme (ACE) inhibitors, β-blockers, or statins or had percutaneous coronary intervention. Logistic regression analysis revealed that age, hypertension, fasting plasma glucose and lower use of ACE inhibitors, β-blockers and percutaneous coronary intervention were independently associated with in-hospital mortality in patients with acute STEMI. CONCLUSION: Higher in-hospital mortality after an acute STEMI in women can be explained by older age, more concomitant diseases and less aggressive treatment.