冠心病患者经皮冠状动脉介入治疗死亡率的性别差异

目的确定经皮冠状动脉介入治疗(PCI)后死亡率是否存在性别差异以及女性是否是影响死亡率的独立预测因素。方法回顾性分析2004年7月1日至2005年9月30日北京安贞医院行单纯PCI治疗的2 493名患者(男性1 860例,女性633例),并进行随访,记录临床特征及随访数据。按照性别分组比较两组之间住院死亡率和总死亡率的差异。结果女性年龄较大,术前合并主要疾病的比例较男性高,而左室射血分数(LVEF)较男性好,既往心肌梗死病史及血运重建史较男性少。女性患者术后住院死亡率约是男性的10倍(女性1.1%,男性0.1%,P<0.001);中位数随访时间555 d,随访率93.4%,女性总死亡率高于男性(5%比2%,P=0.003),总死亡风险是男性的2.6倍(HR2.631,95%CI1.217~5.687,P=0.014)。结论女性PCI术后住院死亡率及总死亡率均高于男性。女性是总死亡率的独立危险因素。

Gender differences in mortality after percutaneous coronary intervention

Objective To investigate gender differences in mortality after percutaneous coronary intervention(PCI) in contemporary "real world" practice and determine whether female gender is an independent risk factor for PCI mortality.Methods A total of 2 493 patients including 1 860 men(male group) and 633 women(female group) who underwent PCI during July 1st,2004 to September 30st,2005 in Beijing Anzhen Hospital were retrospectively investigated and followed up.The risk factors before PCI and the mortality rates post PCI were compared.Results Women undergoing PCI were older and had more comorbidities than men.However,men were more likely to have depressed ejection fraction,prior myocardial infarction,and prior coronary revascularization.Women demonstrated a ten-fold higher in-hospital mortality rates compared with men(1.1% vs 0.1%,P<0.001).A 93.4% of the patients were successfully followed up with a median of 555 days and women had a higher total mortality(5% vs 2%,P=0.003).After adjusting for baseline clinical risk factors,female gender still had higher total mortality risks(adjusted odds ratio 2.631,95% confidence interval 1.217 to 5.687,P=0.014).Conclusion Women had a higher in-hospital as well as long-term mortality rate post PCI compared with men.Female gender was an independent risk factor for total mortality.