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.
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.