急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入术后住院期间死亡率的性别差异

目的探讨性别差异是否影响接受直接经皮冠状动脉介入治疗(PCI)的急性ST段抬高型心肌梗死(STEMI)患者的预后。方法选择2008年1月至2013年12月因急性STEMI住院并接受急诊直接PCI治疗的患者578例。比较男性和女性在基线特征、冠状动脉造影结果及住院期间死亡率方面的差异。结果 578例患者中男性455例(78.7%),女性123例(21.3%)。女性的平均年龄较男性大(68±10)岁比(61±12)岁,t=-6.817,P<0.01],高血压(75.6%比52.3%,χ2=21.484,P<0.01)和糖尿病(43.1%比27.7%,χ2=10.737,P<0.01)的患病率均高于男性;而男性的吸烟比例高于女性(63.5%比13.0%,χ2=99.108,P<0.01)。两组患者的冠状动脉造影结果差异无统计学意义。女性的住院期间死亡率高于男性(8.9%比4.4%,χ2=3.945,P=0.047),校正年龄、高血压、糖尿病、吸烟史和血小板糖蛋白Ⅱb/Ⅲa受体拮抗剂的使用后这种性别差异无统计学意义(OR:1.036,95%CI:0.339³.169,P=0.95)。结论对接受急诊直接PCI治疗的STEMI患者而言,女性的住院期间死亡率高于男性,但这种差异可能是由于本研究样本人群女性年龄偏大、并存疾病更多所致。

Sex differences in outcomes of patients with ST elevation myocardial infarction undergoing primary percutaneous coronary intervention

Objective A higher mortality risk for women with acute ST elevation myocardial infarction （STEMI） has been a common finding in the past. It is unclear if these differences persist among patients undergoing contemporary primary percutaneous coronary intervention （PCI） with focus on early reperfusion in China. Methods We assessed 578 patients with STEMI undergoing acute coronary angiography with the intention of primary PCI between January 2008 and December 2013. Data were examined for gender-specific differences regarding patients＇ characteristics, angiographic findings, procedural details, and in-hospital mortality after PCI. Results A total of 123 women and 455 men were included in the study. Compared with men, women were older than men （68 ＋ 10） years old vs. （61 ± 12） years old, t = -6. 817, P 〈 0. 01 ], and more frequently had a history of hypertension （75.6% vs. 52. 3% ,X2 =21. 484, P 〈0.01 ） and diabetes melfitus （43.1% vs. 27.7% ,X2 = 10. 737, P 〈0. 01 ）. Men were more likely to be smokers. Female sex was associated with a higher unadjusted in-hospital mortality （8.9% vs. 4.4% ,X2 = 3. 945, P = 0. 047）. After multivariable adjustment this sex difference disappeared （OR： 1. 036, 95% CI：0. 339 -3. 169, P = 0.95 ）. Conclusions Female sex is associated with an apparent hazard of increased mortality among patients undergoing primary PCI for STEMI, but this difference is likely explained by older age and worse baseline comorbidities among women.