急性心肌梗死经皮冠状动脉介入术后住院患者临床特征的性别差异及其院内死亡的影响因素分析
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摘要
目的探讨不同性别急性心肌梗死经皮冠状动脉介入术(PCI)后住院患者临床特征的差异情况及院内死亡的影响因素。方法回顾性选取2017年1月1日至12月31日于首都医科大学附属北京安贞医院住院治疗的急性心肌梗死PCI术后患者2 447例,按照性别分为男性组和女性组。比较2组临床特征并采用Logistic回归方法分析患者院内死亡的危险因素。结果 2 447例患者中男性组2 017例,女性组430例。女性组患者年龄、住院时间、出现症状至就诊时间和高血压、糖尿病、高脂血症病史比例及心功能Killip分级≥3级、多支血管病变比例、置入支架数量均明显高于男性组患者,医疗保险付费、吸烟史比例均明显低于男性组患者,差异均有统计学意义(均P <0. 05)。2 447例患者中院内死亡16例,未死亡2 431例。多因素分析结果显示,年龄≥65岁(比值比=3. 25,95%置信区间:1. 63～8. 81,P=0. 006)、心功能Killip分级≥3级(比值比=3. 52,95%置信区间:1. 36～5. 28,P=0. 002)及多支血管病变(比值比=2. 04,95%置信区间:1. 33～4. 37,P=0. 010)是急性心肌梗死行PCI治疗患者院内死亡的独立危险因素。结论急性心肌梗死PCI术后住院女性患者与男性相比,年龄偏大、院前延误较多、住院时间偏长、冠状动脉受累严重、病死率高;而高龄、重度心力衰竭、多支血管病变是院内死亡的独立危险因素。
Objective To analyze the clinical features between patients with different genders with acute myocardial infarction( AMI) and the risk factors of in-hospital death after percutaneous coronary intervention( PCI). Methods A total of 2 447 AMI patients who underwent PCI in Beijing Anzhen Hospital,Capital Medical University from January 1 st to December 31st,2017 were retrospectively analyzed. Clinical data were analyzed between males and females. Risk factors of in-hospital death were analyzed by logistic regression. Results There were 2 017 males and 430 females. Age,hospitalization time,onset to visit time,rates of hypertension,diabetes,hyperlipidemia,Killip grade≥3,multi-vessel disease and the number of stent implantation in female patients were significantly higher than those in male patients; rates of medical insurance payment and smoking history in female patients were significantly lower than those in male patients( all P < 0. 05). There were 16 in-hospital deaths and 2 431 survivals. Multivariate logistic regression showed that age ≥ 65 years[odds ratio( OR) = 3. 25,95%confidence interval( CI) : 1. 63-8. 81,P = 0. 006 ],Killip grade ≥3( OR = 3. 52,95% CI: 1. 36-5. 28,P =0. 002) and multi-vessel disease( OR = 2. 04,95% CI: 1. 33-4. 37,P = 0. 010) were independent risk factors of in-hospital mortality in AMI patients undergoing PCI. Conclusions Female patients with AMI are older and have more delays in pre-hospital treatment,prolonged hospital stay,severer coronary lesion and higher mortality than males. Advanced age,severe heart failure and multi-vessel disease are independent risk factors of in-hospital mortality after PCI.
Objective To analyze the clinical features between patients with different genders with acute myocardial infarction( AMI) and the risk factors of in-hospital death after percutaneous coronary intervention( PCI). Methods A total of 2 447 AMI patients who underwent PCI in Beijing Anzhen Hospital,Capital Medical University from January 1 st to December 31st,2017 were retrospectively analyzed. Clinical data were analyzed between males and females. Risk factors of in-hospital death were analyzed by logistic regression. Results There were 2 017 males and 430 females. Age,hospitalization time,onset to visit time,rates of hypertension,diabetes,hyperlipidemia,Killip grade≥3,multi-vessel disease and the number of stent implantation in female patients were significantly higher than those in male patients; rates of medical insurance payment and smoking history in female patients were significantly lower than those in male patients( all P < 0. 05). There were 16 in-hospital deaths and 2 431 survivals. Multivariate logistic regression showed that age ≥ 65 years[odds ratio( OR) = 3. 25,95%confidence interval( CI) : 1. 63-8. 81,P = 0. 006 ],Killip grade ≥3( OR = 3. 52,95% CI: 1. 36-5. 28,P =0. 002) and multi-vessel disease( OR = 2. 04,95% CI: 1. 33-4. 37,P = 0. 010) were independent risk factors of in-hospital mortality in AMI patients undergoing PCI. Conclusions Female patients with AMI are older and have more delays in pre-hospital treatment,prolonged hospital stay,severer coronary lesion and higher mortality than males. Advanced age,severe heart failure and multi-vessel disease are independent risk factors of in-hospital mortality after PCI.
引文
[1]Li J,Li X,Wang Q,et al.ST-segment elevation myocardial infarction in China from 2001 to 2011(the China PEACE-Retrospective Acute Myocardial Infarction Study):a retrospective analysis of hospital data[J].Lancet,2015,385(9966):441-451.DOI:10.1016/S0140-6736(14)60921-1.
[2]Szummer K,Wallentin L,Lindhagen L,et al.Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments:experiences from the SWEDEHEART registry 1995-2014[J].Eur Heart J,2017,38(41):3056-3065.DOI:10.1093/eurheartj/ehx515.
[3]Benjamin EJ,Virani SS,Callaway CW,et al.Heart disease and stroke statistics-2018 update:a report from the American Heart Association[J].Circulation,2018,137(12):e67-e492.DOI:10.1161/CIR.0000000000000558.
[4]徐明珠,何志松,周亚峰,等.近十年苏州地区急性心肌梗死患者危险因素演变趋势及急诊PCI治疗现状[J].中国急救医学,2017,37(9):794-799.DOI:10.3969/j.issn.1002-1949.2017.09.005.Xu MZ,He ZS,Zhou YF,et al.Cardiovascular risk factors difference in the trends of patients with acute myocardial infarction and the current status of primary PCI treatment in Suzhou in recent 10 years[J].Chinese Journal of Critical Care Medicine,2017,37(9):794-799.DOI:10.3969/j.issn.1002-1949.2017.09.005.
[5]李昭,李南,马丽,等.青年急性心肌梗死患者流行病学特征分析[J].中国医药,2017,12(4):486-490.DOI:10.3760/cma.j.issn.1673-4777.2017.04.002.Li Z,Li N,Ma L,et al.Epidemiological characteristics of acute myocardial infarction in young adults[J].China Medicine,2017,12(4):486-490.DOI:10.3760/cma.j.issn.1673-4777.2017.04.002.
[6]Mehta LS,Beckie TM,De Von HA,et al.Acute myocardial infarction in women:a scientific statement from the American Heart Association[J].Circulation,2016,133(9):916-947.DOI:10.1161/CIR.0000000000000351.
[7]Mosca L,Benjamin EJ,Berra K,et al.Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update:a guideline from the American Heart Association[J].J Am Coll Cardiol,2011,57(12):1404-1423.DOI:10.1016/j.jacc.2011.02.005.
[8]Yousefzadeh G,Mahdavi-Jafari F,Shokoohi M,et al.Modulation of coronary artery disease risk factors by menopausal status:Apopulation based study among Iranian women(KERCADRStudy)[J].ARYA Atheroscler,2013,9(6):332-336.
[9]Pelletier R,Humphries KH,Shimony A,et al.Sex-related differences in access to care among patients with premature acute coronary syndrome[J].CMAJ,2014,186(7):497-504.DOI:10.1503/cmaj.131450.
[10]邬振宇,刘西平.青年急性心肌梗死患者临床特点分析[J].临床内科杂志,2018,35(7):482-484.DOI:10.3969/j.issn.1001-9057.2018.07.016.Wu ZY,Liu XP.Clinical characteristics of young patients with acute myocardial infarction[J].Journal of Clinical Internal Medicine,2018,35(7):482-484.DOI:10.3969/j.issn.1001-9057.2018.07.016.
[11]Wenger NK,Arnold A,Bairey Merz CN,et al.Hypertension across a woman's life cycle[J].J Am Coll Cardiol,2018,71(16):1797-1813.DOI:10.1016/j.jacc.2018.02.033.
[12]袁涛,李娟,赵维纲,等.雌激素对小鼠胰岛素敏感性及脂肪因子的影响[J].中国医学科学院学报,2015,37(3):269-273.DOI:10.3881/j.issn.1000-503X.2015.03.004.Yuan T,Li J,Zhao WG,et al.Effects of estrogen on insulin sensitivity and adipokines in mice[J].Acta Academiae Medicinae Sinicae,2015,37(3):269-273.DOI:10.3881/j.issn.1000-503X.2015.03.004.
[13]Tiano JP,Delghingaro-Augusto V,Le May C,et al.Estrogen receptor activation reduces lipid synthesis in pancreatic islets and preventsβcell failure in rodent models of type 2 diabetes[J].J Clin Invest,2011,121(8):3331-3342.DOI:10.1172/JCI44564.
[14]Yusuf S,Hawken S,Ounpuu S,et al.Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries(the INTERHEART study):case-control study[J].Lancet,2004,364(9438):937-952.DOI:10.1016/S0140-6736(04)17018-9.
[15]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2017》概要[J].中国循环杂志,2018,33(1):1-8.DOI:10.3969/j.issn.1000-3614.2018.01.001.Chen WW,Gao RL,Liu LS,et al.Summary of China cardiovascular disease report 2017[J].Chinese Circulation Journal,2018,33(1):1-8.DOI:10.3969/j.issn.1000-3614.2018.01.001.
[16]Nguyen HL,Saczynski JS,Gore JM,et al.Age and sex differences in duration of prehospital delay in patients with acute myocardial infarction:a systematic review[J].Circ Cardiovasc Qual Outcomes,2010,3(1):82-92.DOI:10.1161/CIRCOUTCOMES.109.884361.
[17]Roberto RB,Valmin RS,Renato GS,et al.Gender differences in primary percutaneous coronary intervention outcomes in patients with ST-elevation myocardial infarction[J].Revista Brasileira de Cardiologia Invasiva(English Edition),2015,23(2):96-101.DOI:10.1016/j.rbciev.2015.12.006.
[18]Wijnbergen I,Tijssen J,van't Veer M,et al.Gender differences in long-term outcome after primary percutaneous intervention for ST-segment elevation myocardial infarction[J].Catheter Cardiovasc Interv,2013,82(3):379-384.DOI:10.1002/ccd.24800.
[19]Mendelsohn ME,Karas RH.The protective effects of estrogen on the cardiovascular system[J].N Engl J Med,1999,340(23):1801-1811.DOI:10.1056/NEJM199906103402306.
[20]Fu WX,Zhou TN,Wang XZ,et al.Sex-related differences in short-and long-term outcome among young and middle-aged patients for ST-segment elevation myocardial infarction underwent percutaneous coronary intervention[J].Chin Med J(Engl),2018,131(12):1420-1429.DOI:10.4103/0366-6999.233965.
[21]Berg J,Bj9rck L,Nielsen S,et al.Sex differences in survival after myocardial infarction in Sweden,1987-2010[J].Heart,2017,103(20):1625-1630.DOI:10.1136/heartjnl-2016-310281.
[22]代冰冰,何学明.急性心肌梗死患者院内死亡危险因素分析[J].临床内科杂志,2017,34(4):247-250.DOI:10.3969/j.issn.1001-9057.2017.04.010.Dai BB,He XM.Risk factors analysis of in-hospital death in patients with acute myocardial infarction[J].Journal of Clinical Internal Medicine,2017,34(4):247-250.DOI:10.3969/j.issn.1001-9057.2017.04.010.
[23]Zhang L,Wang F,Wang L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,379(9818):815-822.DOI:10.1016/S0140-6736(12)60033-6.
[24]Xu Y,Wang L,He J,et al.Prevalence and control of diabetes in Chinese adults[J].JAMA,2013,310(9):948-959.DOI:10.1001/jama.2013.168118.
[25]Celermajer DS,Chow CK,Marijon E,et al.Cardiovascular disease in the developing world:prevalences,patterns,and the potential of early disease detection[J].J Am Coll Cardiol,2012,60(14):1207-1216.DOI:10.1016/j.jacc.2012.03.074.
[2]Szummer K,Wallentin L,Lindhagen L,et al.Improved outcomes in patients with ST-elevation myocardial infarction during the last 20 years are related to implementation of evidence-based treatments:experiences from the SWEDEHEART registry 1995-2014[J].Eur Heart J,2017,38(41):3056-3065.DOI:10.1093/eurheartj/ehx515.
[3]Benjamin EJ,Virani SS,Callaway CW,et al.Heart disease and stroke statistics-2018 update:a report from the American Heart Association[J].Circulation,2018,137(12):e67-e492.DOI:10.1161/CIR.0000000000000558.
[4]徐明珠,何志松,周亚峰,等.近十年苏州地区急性心肌梗死患者危险因素演变趋势及急诊PCI治疗现状[J].中国急救医学,2017,37(9):794-799.DOI:10.3969/j.issn.1002-1949.2017.09.005.Xu MZ,He ZS,Zhou YF,et al.Cardiovascular risk factors difference in the trends of patients with acute myocardial infarction and the current status of primary PCI treatment in Suzhou in recent 10 years[J].Chinese Journal of Critical Care Medicine,2017,37(9):794-799.DOI:10.3969/j.issn.1002-1949.2017.09.005.
[5]李昭,李南,马丽,等.青年急性心肌梗死患者流行病学特征分析[J].中国医药,2017,12(4):486-490.DOI:10.3760/cma.j.issn.1673-4777.2017.04.002.Li Z,Li N,Ma L,et al.Epidemiological characteristics of acute myocardial infarction in young adults[J].China Medicine,2017,12(4):486-490.DOI:10.3760/cma.j.issn.1673-4777.2017.04.002.
[6]Mehta LS,Beckie TM,De Von HA,et al.Acute myocardial infarction in women:a scientific statement from the American Heart Association[J].Circulation,2016,133(9):916-947.DOI:10.1161/CIR.0000000000000351.
[7]Mosca L,Benjamin EJ,Berra K,et al.Effectiveness-based guidelines for the prevention of cardiovascular disease in women--2011 update:a guideline from the American Heart Association[J].J Am Coll Cardiol,2011,57(12):1404-1423.DOI:10.1016/j.jacc.2011.02.005.
[8]Yousefzadeh G,Mahdavi-Jafari F,Shokoohi M,et al.Modulation of coronary artery disease risk factors by menopausal status:Apopulation based study among Iranian women(KERCADRStudy)[J].ARYA Atheroscler,2013,9(6):332-336.
[9]Pelletier R,Humphries KH,Shimony A,et al.Sex-related differences in access to care among patients with premature acute coronary syndrome[J].CMAJ,2014,186(7):497-504.DOI:10.1503/cmaj.131450.
[10]邬振宇,刘西平.青年急性心肌梗死患者临床特点分析[J].临床内科杂志,2018,35(7):482-484.DOI:10.3969/j.issn.1001-9057.2018.07.016.Wu ZY,Liu XP.Clinical characteristics of young patients with acute myocardial infarction[J].Journal of Clinical Internal Medicine,2018,35(7):482-484.DOI:10.3969/j.issn.1001-9057.2018.07.016.
[11]Wenger NK,Arnold A,Bairey Merz CN,et al.Hypertension across a woman's life cycle[J].J Am Coll Cardiol,2018,71(16):1797-1813.DOI:10.1016/j.jacc.2018.02.033.
[12]袁涛,李娟,赵维纲,等.雌激素对小鼠胰岛素敏感性及脂肪因子的影响[J].中国医学科学院学报,2015,37(3):269-273.DOI:10.3881/j.issn.1000-503X.2015.03.004.Yuan T,Li J,Zhao WG,et al.Effects of estrogen on insulin sensitivity and adipokines in mice[J].Acta Academiae Medicinae Sinicae,2015,37(3):269-273.DOI:10.3881/j.issn.1000-503X.2015.03.004.
[13]Tiano JP,Delghingaro-Augusto V,Le May C,et al.Estrogen receptor activation reduces lipid synthesis in pancreatic islets and preventsβcell failure in rodent models of type 2 diabetes[J].J Clin Invest,2011,121(8):3331-3342.DOI:10.1172/JCI44564.
[14]Yusuf S,Hawken S,Ounpuu S,et al.Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries(the INTERHEART study):case-control study[J].Lancet,2004,364(9438):937-952.DOI:10.1016/S0140-6736(04)17018-9.
[15]陈伟伟,高润霖,刘力生,等.《中国心血管病报告2017》概要[J].中国循环杂志,2018,33(1):1-8.DOI:10.3969/j.issn.1000-3614.2018.01.001.Chen WW,Gao RL,Liu LS,et al.Summary of China cardiovascular disease report 2017[J].Chinese Circulation Journal,2018,33(1):1-8.DOI:10.3969/j.issn.1000-3614.2018.01.001.
[16]Nguyen HL,Saczynski JS,Gore JM,et al.Age and sex differences in duration of prehospital delay in patients with acute myocardial infarction:a systematic review[J].Circ Cardiovasc Qual Outcomes,2010,3(1):82-92.DOI:10.1161/CIRCOUTCOMES.109.884361.
[17]Roberto RB,Valmin RS,Renato GS,et al.Gender differences in primary percutaneous coronary intervention outcomes in patients with ST-elevation myocardial infarction[J].Revista Brasileira de Cardiologia Invasiva(English Edition),2015,23(2):96-101.DOI:10.1016/j.rbciev.2015.12.006.
[18]Wijnbergen I,Tijssen J,van't Veer M,et al.Gender differences in long-term outcome after primary percutaneous intervention for ST-segment elevation myocardial infarction[J].Catheter Cardiovasc Interv,2013,82(3):379-384.DOI:10.1002/ccd.24800.
[19]Mendelsohn ME,Karas RH.The protective effects of estrogen on the cardiovascular system[J].N Engl J Med,1999,340(23):1801-1811.DOI:10.1056/NEJM199906103402306.
[20]Fu WX,Zhou TN,Wang XZ,et al.Sex-related differences in short-and long-term outcome among young and middle-aged patients for ST-segment elevation myocardial infarction underwent percutaneous coronary intervention[J].Chin Med J(Engl),2018,131(12):1420-1429.DOI:10.4103/0366-6999.233965.
[21]Berg J,Bj9rck L,Nielsen S,et al.Sex differences in survival after myocardial infarction in Sweden,1987-2010[J].Heart,2017,103(20):1625-1630.DOI:10.1136/heartjnl-2016-310281.
[22]代冰冰,何学明.急性心肌梗死患者院内死亡危险因素分析[J].临床内科杂志,2017,34(4):247-250.DOI:10.3969/j.issn.1001-9057.2017.04.010.Dai BB,He XM.Risk factors analysis of in-hospital death in patients with acute myocardial infarction[J].Journal of Clinical Internal Medicine,2017,34(4):247-250.DOI:10.3969/j.issn.1001-9057.2017.04.010.
[23]Zhang L,Wang F,Wang L,et al.Prevalence of chronic kidney disease in China:a cross-sectional survey[J].Lancet,2012,379(9818):815-822.DOI:10.1016/S0140-6736(12)60033-6.
[24]Xu Y,Wang L,He J,et al.Prevalence and control of diabetes in Chinese adults[J].JAMA,2013,310(9):948-959.DOI:10.1001/jama.2013.168118.
[25]Celermajer DS,Chow CK,Marijon E,et al.Cardiovascular disease in the developing world:prevalences,patterns,and the potential of early disease detection[J].J Am Coll Cardiol,2012,60(14):1207-1216.DOI:10.1016/j.jacc.2012.03.074.