75岁及以上不同性别老年冠心病患者经皮冠状动脉介入治疗术后的预后分析

目的探讨不同性别的老年冠心病患者行经皮冠状动脉介入治疗(PCI)后,短期及1年期预后的差异。方法前瞻性连续纳入行PCI治疗的75岁以上老年患者1 105例,其中男性739例,女性366例。比较两组患者的临床基线特征、手术结局及临床预后。结果老年男性患者的吸烟率(20.3%比5.7%,χ2=39.670)、心肌梗死病史(27.9%比19.9%,χ2=8.156)及肌酐异常比例(20.2%比10.9%,χ2=14.718)均高于女性(均为P<0.01);而老年女性患者的高血压患病率(73.2%比65.8%,χ2=6.284,P<0.01)、血红蛋白异常比例(20.5%比15.8%,χ2=3.702,P=0.054)均高于男性。老年男性患者采用血管内超声的比例高于女性(5.8%比1.9%,χ2=8.645,P<0.01),选用桡动脉路径的比例也高于女性(79.6%比73.2%,χ2=5.642,P=0.02)。老年女性患者的院内净不良临床事件率显著高于男性(7.7%比3.9%,χ2=6.946,P<0.01),主要源于穿刺点相关的大出血事件率的差异(3.0%比0.5%,χ2=11.100,P<0.01)。老年男性与女性患者1年期主要不良心血管事件率差异无统计学意义(6.2%比7.9%,χ2=1.117,P=0.29);同时1年期的死亡、心肌梗死、靶血管重建事件率差异也无统计学意义(均为P>0.05)。结论行PCI治疗的老年女性患者院内净不良临床事件率高于男性患者,主要为穿刺点相关的大出血事件的差异。对老年女性患者的穿刺点进行有效管理是提高PCI质量的重要方式。

Gender differences of the in-hospital and follow-up outcomes in elderly patients undergoing percutaneous coronary intervention

Objective To evaluate the gender differences of the short-term and 1-year outcomes in elderly patients undergoing PCI. Methods The 1 105 elderly patients undergone PCI were consecutively recruited. Among them,739 were males,366 were females. The clinical features,procedure outcomes and clinical prognosis were compared between the two groups. Results The prevalence of smoking（ 20. 3% vs.5. 7%,χ^2= 39. 670,P〈0. 01）,prior myocardial infarction（ 27. 9% vs. 19. 9%,χ^2= 8. 156,P〈0. 01）as well as the proportion of abnormal serum creatine（ 20. 2% vs. 10. 9%,χ^2= 14. 718,P〈0. 01） were significantly higher in men than in women. The prevalence of hypertension（ 73. 2% vs. 65. 8%,χ^2=6. 284,P〈0. 01） as well as the proportion of anemia（ 20. 5% vs. 15. 8%,χ^2= 3. 702,P = 0. 054） was significantly higher in women than in men. The rates of intravascular ultrasound（ 5. 8% vs. 1. 9%,χ^2=8. 645,P〈0. 01） and radial access（ 79. 6% vs. 73. 2%,χ^2= 5. 642,P = 0. 02） were significantly higher in men than in women. The rate of in-hospital NACE was significantly higher in women than in man（ 7. 7%vs. 3. 9%,χ^2= 6. 946,P〈0. 01）,mainly driven by the higher rate of access site-related major bleeding（ 3.0% vs. 0.5%,χ^2= 11. 100,P〈0. 01）. No significant difference was detected of 1 year MACE between men and women（ 6. 2% vs. 7. 9%,χ^2= 1. 117,P = 0. 29）,and the rates of death,myocardial infarction and target vessel revascularization were also similar between men and women（ all P〈0. 05）.Conclusions The in-hospital NACE is significantly higher in elderly women compared with elderly men who have undergone PCI,which is mainly driven by the difference of access site-related major bleeding. Proper management of the access site bleeding is an effective way in improving PCI quality in elderly women.