女性ST段抬高型心肌梗死患者院内病死率的研究

目的:研究ST段抬高型心肌梗死(STEMI)患者的院内病死率的性别差异及其原因。方法:入选急性心肌梗死(AMI)患者共1 189例,其中男性869例,女性320例。先比较女性与男性之间年龄,合并症等基线资料和典型症状,院内病死率等临床资料的差异,再分析STEMI患者院内病死率的性别差异。结果:与男性比较,女性STEMI患者年龄大(68.51岁vs.60.76岁,P0.001),2型糖尿病、高血压患病率高(24.4%vs.14.6%,P0.001;61.3%vs.42.2%,P0.001),脑力劳动者少(3.4%vs.23.7%,P0.001),吸烟和饮酒者少(27.2%vs.68.1%,P0.001;2.2%vs.27.0%,P0.001);女性患者中有明显诱因和出现典型胸痛者少(27.5%vs.35.9%,P=0.008;50.9%vs.68.2%,P0.001),出现并发症者多(41.9%vs.32.2%,P=0.002),接受急诊再灌注治疗比例低(67.2%vs.77.7%,P0.001),院内病死率高(17.5%vs.7.9%,P0.001)。女性对STEMI患者院内病死率的影响很明显(OR 2.459,95%CI 1.684~3.593,P0.001);校正年龄,2型糖尿病,高血压等因素的影响后,STEMI患者院内病死率的性别差异消失(P=0.109),而年龄,高血压和低急诊再灌注治疗率为STEMI患者院内病死率增高的独立危险因素(P0.001,P=0.022,P0.001)。结论:女性STEMI患者的院内病死率高于男性。这是由于女性STEMI患者年龄大,合并高血压者多,接受急诊再灌注治疗的比率低所致。女性不是造成STEM2患者院内病死率增高的独立危险因素。

Study on in-hospital mortality in female patients with ST-segment elevation myocardial infarction

Objective：To analyze in-hospital mortality in female patients with ST-segment elevation myocardial infarction （STEMI）.Methods：1 189 patients were enrolled.At first,320 female patients were compared with 869 male patients about baseline （i.e.age,comorbidity,etc） and clinical factors （i.e.typical angina pectoris,in-hospital mortality,etc）.Then analyze gender defferences of in-hospital mortality in a multivariate model.Results：Compared with male patients,female patients were older（68.51 years vs.60.76 years,P ＜ 0.001）,the morbidities of type 2 diabetes mellitus and hypertension were significant higher in female patients （24.4％ vs.14.6％,P ＜ 0.001 ; 61.3％ vs.42.2％,P ＜ 0.001,respectively）,the rates of mental labors,smokers,drinkers were significant lower in female patients （3.4％ vs.23.7％,P ＜ 0.001 ; 27.2％ vs.68.1％,P ＜ 0.001 ;2.2％ vs.27.0％,P ＜ 0.001 ; respectively） ; Female patients were presented with less triggering factors and typical symptoms but more complications （27.5％ vs.35.9％,P =0.008 ;50.9％ vs.68.2％,P ＜0.001 ; 41.9％ vs.32.2％,P =0.002,respectively）,fewer female patients accepted actue reperfusion therapy （67.2％ vs.77.7％,P ＜ 0.001）.In-hospital mortality in female patients were significant higher than in male patients（17.5％ vs.7.9％,P ＜0.001）,multivariate analysis revealed that female gender was not an independent predictor of in-hospital mortality （P =0.109）,while age,hypertension and lower rates of acute reperfusion therapy were independent predictors of in-hospital mortality （P ＜ 0.001,P =0.022,P ＜ 0.001,respectively）.Conclusion：In-hospital mortality in female patients with STEMI were significant higher than in male patients.This is because of the gender difference of age,hypertension and acute reperfusion therapy,female gender was not an independent predictor of in-hospital mortality in patients with STEMI.