1069例急性心肌梗死住院患者临床特点及冠脉造影分析
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摘要
目的探讨AMI住院患者临床特点、冠脉造影情况及其在不同性别之间的差异。方法纳入石河子大学第一附属医院2016年1月1日至2017年12月31日收治的AMI患者1069例(男性816例,女性253例),分析其危险因素、合并疾病、并发症、冠脉造影情况并在不同性别中进行比较。结果合并吸烟史、超重或肥胖、高血压依次占53.3%、57.2%、53.9%;罪犯血管为前降支及右冠占76.0%,多支病变及双支病变占78.5%;并发症以心力衰竭(28.3%)及心律失常(12.8%)为主,院内死亡占9.0%。与男性相比,女性合并高血压、糖尿病、高尿酸血症、肾功能不全者较多(69.2%比49.1%、40.7%比30.0%、25.3%比15.0%、20.2%比12.9%,P<0.01),合并吸烟、饮酒、肝功能异常者较少(68.0%比5.9%、36.4%比26.8%、33.6%比20.6%,P<0.01);女性院内并发死亡、心力衰竭、乳头肌功能失调或断裂、瓣膜关闭不全较多(15.4%比7.0%、36.0%比26.0%、2.4%比0.1%、7.9%比4.0%、9.5%比2.8%,P<0.05或P<0.01);女性急诊PCI较少(28.5%比42.4%,P<0.01),女性多支血管病变较多(60.5%比42.8%,P<0.01)。结论石河子大学第一附属医院AMI住院患者合并吸烟史、超重或肥胖、高血压者较多;罪犯血管以前降支及右冠为主,大部分患者为双支或多支血管病变。与男性患者相比,女性合并慢性疾病较多,女性急诊PCI比例较低,以多支血管病变为主,女性院内死亡及并发症较多。
Objective To explore the clinical and coronary angiographic characteristics and their differences between genders in hospitalized patients with acute myocardial infarction(AMI).Methods A total 1069 AMI patients were enrolled in this study from the First Affiliated Hospital of Shihezi University between January 1,2016 and December 31,2017.Risk factors,complications and angiographic characteristics were analyzed and compared between genders.Results Patients with smoking history,overweight/obesity and hypertension accounted for 53.3%,57.2%,and 53.9%,respectively.Of the culprit vessels,anterior descending artery and right coronary artery accounted for 76.0%,and multi-vessel and bi-vessel lesions accounted for 78.5%.The main complications were heart failure(28.3%) and arrhythmia(12.8%).The hospital death rate was 9%.The incidences of hypertension,diabetes,hyperuricemia,renal insufficiency,hospital death,heart failure,papillary muscle dysfunction or rupture,valvular insufficiency and multi-vessel lesions in females were higher than those in males(69.2% vs 49.1%,40.7% vs 30.0%,25.3% vs 15.0%,20.2% vs 12.9%,15.4% vs 7.0%,36.0% vs 26.0%,2.4% vs 0.1%,7.9% vs 4.0%,9.5% vs 2.8% and 60.5% vs 42.8%,respectively; P<0.05 or P<0.01).However,the incidences of smoking,drinking,liver dysfunction and emergency PCI in females were lower than those in males(68.0% vs 5.9%,36.4% vs 26.8%,33.6% vs 20.6% and 28.5% vs 42.4%,respectively;P<0.01).Conclusion Most of the AMI patients hospitalized in the First Affiliated Hospital of Shihezi University had smoking history,overweight/obesity or hypertension and presented with multi-vessel or bi-vessel lesions.Anterior descending artery and right coronary artery are the main culprit vessels.Compared with male AMI patients,the incidences of chronic diseases,multi-vessel lesions,hospital death and complications increased but the rate of emergency PCI decreased in female AMI patients.
Objective To explore the clinical and coronary angiographic characteristics and their differences between genders in hospitalized patients with acute myocardial infarction(AMI).Methods A total 1069 AMI patients were enrolled in this study from the First Affiliated Hospital of Shihezi University between January 1,2016 and December 31,2017.Risk factors,complications and angiographic characteristics were analyzed and compared between genders.Results Patients with smoking history,overweight/obesity and hypertension accounted for 53.3%,57.2%,and 53.9%,respectively.Of the culprit vessels,anterior descending artery and right coronary artery accounted for 76.0%,and multi-vessel and bi-vessel lesions accounted for 78.5%.The main complications were heart failure(28.3%) and arrhythmia(12.8%).The hospital death rate was 9%.The incidences of hypertension,diabetes,hyperuricemia,renal insufficiency,hospital death,heart failure,papillary muscle dysfunction or rupture,valvular insufficiency and multi-vessel lesions in females were higher than those in males(69.2% vs 49.1%,40.7% vs 30.0%,25.3% vs 15.0%,20.2% vs 12.9%,15.4% vs 7.0%,36.0% vs 26.0%,2.4% vs 0.1%,7.9% vs 4.0%,9.5% vs 2.8% and 60.5% vs 42.8%,respectively; P<0.05 or P<0.01).However,the incidences of smoking,drinking,liver dysfunction and emergency PCI in females were lower than those in males(68.0% vs 5.9%,36.4% vs 26.8%,33.6% vs 20.6% and 28.5% vs 42.4%,respectively;P<0.01).Conclusion Most of the AMI patients hospitalized in the First Affiliated Hospital of Shihezi University had smoking history,overweight/obesity or hypertension and presented with multi-vessel or bi-vessel lesions.Anterior descending artery and right coronary artery are the main culprit vessels.Compared with male AMI patients,the incidences of chronic diseases,multi-vessel lesions,hospital death and complications increased but the rate of emergency PCI decreased in female AMI patients.
引文
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[9] ZONG G,LI Y P,SAMPSON L,et al.Monounsaturated fats from plant and animal sources in relation to risk of coronary heart disease among US men and women[J].Am J Clin Nutr,2018,107(3):445-453.
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[11] 张娟娟,齐颖,唐志远,等.不同性别高尿酸血症患者的影响因素调查[J].重庆医学,2018,47(16):2193-2196,2200.
[12] MAHMOUD K S,ABD AL Rahman T,TAHA H,et al.Significance of ST-segment deviation in Lead aVR for prediction of culprit artery and infarct size in acute inferior wall ST-elevation myocardial infarction[J].Egyptian Heart Journal,2015,67(2):145-149.
[13] JARRAH M I,HAMMOUDEH A J,AL NATOUR D B,et al.Gender differences in risk profile and outcome of Middle Eastern patients undergoing percutaneous coronary intervention[J].Saudi Med J,2017,38(2):149-155.
[14] 张莉莉,高阳,丁建,等.不同性别急性心梗患者的临床特征及院内治疗预后分析[J].现代生物医学进展,2016,16(7):1299-1302.
[15] AGGARWAL N R,PATEL H N,MEHTA L S,et al.Sex differences in ischemic heart disease:advances,obstacles,and next steps[J].Circ Cardiovasc Qual Outcomes,2018,11(2):e004437.
[16] WANG X,HSU L L.Treatment-seeking delays in patients with acute myocardial infarction and use of the emergency medical service[J].J Int Med Res,2013,41(1):231-238.
[2] WHITE H D,THYGESEN K,ALPERT J S,et al.Clinical implications of the third universal definition of myocardial infarction[J].Heart,2014,100(5):424-432.
[3] 王薇,赵冬.中国心脑血管病流行特征转化规律、影响因素及预防策略研究与应用[J].中华心血管病杂志,2013,41(11):992.
[4] 丁清琳.急性心肌梗死患者发病率及死亡率与性别年龄关系[J].安徽医学,2008,29(5):627-628.
[5] 张军华.中国急性心肌梗死患者心血管危险因素分析[J/OL].临床医药文献杂志(电子版),2018,5(62):33-37[2018-11-01].http://www.wanfangdata.com.cn/details/detail.do?_type=perio&id=lcyydzzz201862028.
[6] 高晓津,杨进刚,杨跃进,等.中国急性心肌梗死患者心血管病危险因素分析[J].中华高血压杂志,2016,24(1):100.
[7] KOSTAPANOS M S,FLORENTIN M,ELISAF M S.Gender differences in the epidemiology,clinical presentation,prevention,and prognosis of acute coronary syndromes[J].Angiology,2013,64(1):5-8.
[8] HEER T,HOCHADEL M,SCHMIDT K,et al.Gender differences in therapeutic recommendation after diagnostic coronary angiography:insights from the Coronary Angiography and PCI Registry of the German Society of Cardiology[J].Clin Res Cardiol,2015,104(6):507-517.
[9] ZONG G,LI Y P,SAMPSON L,et al.Monounsaturated fats from plant and animal sources in relation to risk of coronary heart disease among US men and women[J].Am J Clin Nutr,2018,107(3):445-453.
[10] 何培源,杨跃进,乔树宾,等.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[J].中国心血管杂志,2014,19(4):241-245.
[11] 张娟娟,齐颖,唐志远,等.不同性别高尿酸血症患者的影响因素调查[J].重庆医学,2018,47(16):2193-2196,2200.
[12] MAHMOUD K S,ABD AL Rahman T,TAHA H,et al.Significance of ST-segment deviation in Lead aVR for prediction of culprit artery and infarct size in acute inferior wall ST-elevation myocardial infarction[J].Egyptian Heart Journal,2015,67(2):145-149.
[13] JARRAH M I,HAMMOUDEH A J,AL NATOUR D B,et al.Gender differences in risk profile and outcome of Middle Eastern patients undergoing percutaneous coronary intervention[J].Saudi Med J,2017,38(2):149-155.
[14] 张莉莉,高阳,丁建,等.不同性别急性心梗患者的临床特征及院内治疗预后分析[J].现代生物医学进展,2016,16(7):1299-1302.
[15] AGGARWAL N R,PATEL H N,MEHTA L S,et al.Sex differences in ischemic heart disease:advances,obstacles,and next steps[J].Circ Cardiovasc Qual Outcomes,2018,11(2):e004437.
[16] WANG X,HSU L L.Treatment-seeking delays in patients with acute myocardial infarction and use of the emergency medical service[J].J Int Med Res,2013,41(1):231-238.