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[性别和年龄对急性ST段抬高型心肌梗死患者院内主要心血管和脑血管不良事件的影响]

[Impact of gender and age on in-hospital major adverse cardiovascular and cerebrovascular events of patients with acute ST-segment elevation myocardial infarction].

作者信息

Shen Q N, Wang D X, Zhai H B, Dong Z C, Liu J, Zhang B

机构信息

Department of Cardiology, First Affiliated Hospital, Dalian Medical University, Dalian 116011, China.

出版信息

Zhonghua Xin Xue Guan Bing Za Zhi. 2017 Apr 24;45(4):288-293. doi: 10.3760/cma.j.issn.0253-3758.2017.04.007.

Abstract

To investigate the impact of gender and age on in-hospital major adverse cardiovascular and cerebrovascular events of patients with acute ST-segment elevation myocardial infarction (STEMI). This is a retrospective single-center study. A total of consecutive 1 102 patients with acute STEMI admitted to our hospital from January 2001 to December 2010 were recruited and clinical data were analyzed. The primary end point was in-hospital death due to any cause, and the secondary end point was in-hospital composite end point including death, re-infarction and stroke. Multivariate logistic regression analyses were performed to identify the risk factors of in hospital death and composite end point. The study population included 283(25.7%(283/1 102)) female patients and female patients were older than male patients ((68.7±11.2)years vs. (59.2±12.5)years, <0.001). Compared with male patients, less female patients received primary percutaneous coronary intervention (50.9%(144/283) vs. 70.9%(581/819), <0.001), had higher rates of in hospital death(10.6%(30/283)vs. 6.0%(36/819), <0.001) and composite endpoint(14.1%(40/283)vs. 7.0%(57/819), <0.001). Among STEMI patients aged <60 years, no differences were found in in-hospital mortality (1.7%(1/58)vs. 1.4%(6/437)) and composite endpoint(3.6%(3/58)vs. 3.4%(15/437)) rates between female and male patients (both >0.05). Among STEMI patients aged ≥60 years, female patients had higher in-hospital mortality (12.9%(29/225)vs. 7.9%(30/382), <0.001), and there was no difference on composite endpoint between female and male patients (16.4%(37/225)vs. 11.0%(42/382), =0.054). Multivariate logistic regression analysis showed that female gender was not the independent risk factor of in-hospital death(=1.029, 95% 0.564-1.877, =0.926) and composite end point(=1.593, 95% 0.989-2.566, =0.055), but age was the independent risk factor of in-hospital death(=1.065, 95% 1.037-1.094, <0.001) and composite end point(=1.050, 95% 1.029-1.071, <0.001)in STEMI patients. Multivariate logistic regression analysis also showed that female was not the independent risk factor of in-hospital death(=1.539, 95% 0.572-4.142, =0.394) and composite end point(=1.563, 95% 0.689-3.546, =0.285), but age was the independent risk factor of in-hospital death(=1.052, 95% 1.011-1.096, =0.013) and composite end point(=1.042, 95% 1.008-1.077, =0.016)in STEMI patients received primary percutaneous coronary intervention. Female patients with STEMI have higher incidence of in-hospital major adverse cardiovascular and cerebrovascular events than male patients, and age is the independent risk factor of in-hospital major adverse cardiovascular and cerebrovascular events of STEMI patients.

摘要

探讨性别和年龄对急性ST段抬高型心肌梗死(STEMI)患者院内主要不良心血管和脑血管事件的影响。这是一项回顾性单中心研究。纳入了2001年1月至2010年12月期间我院连续收治的1102例急性STEMI患者,并对其临床资料进行分析。主要终点是任何原因导致的院内死亡,次要终点是包括死亡、再梗死和卒中的院内复合终点。进行多因素logistic回归分析以确定院内死亡和复合终点的危险因素。研究人群包括283例(25.7%(283/1102))女性患者,女性患者年龄大于男性患者((68.7±11.2)岁对(59.2±12.5)岁,<0.001)。与男性患者相比,接受直接经皮冠状动脉介入治疗的女性患者较少(50.9%(144/283)对70.9%(581/819),<0.001),院内死亡率(10.6%(30/283)对6.0%(36/819),<0.001)和复合终点发生率(14.1%(40/283)对7.0%(57/819),<0.001)较高。在年龄<60岁的STEMI患者中,女性和男性患者的院内死亡率(1.7%(1/58)对1.4%(6/437))和复合终点发生率(3.6%(3/58)对3.4%(15/437))无差异(均>0.05)。在年龄≥60岁的STEMI患者中,女性患者院内死亡率较高(12.9%(29/225)对7.9%(30/382),<0.001),女性和男性患者复合终点无差异(16.4%(37/225)对11.0%(42/382),=0.054)。多因素logistic回归分析显示,女性不是院内死亡(=1.029,95% 0.564 - 1.877,=0.926)和复合终点(=1.593,95% 0.989 - 2.566,=0.055)的独立危险因素,但年龄是STEMI患者院内死亡(=1.065,95% 1.037 - 1.094,<0.001)和复合终点(=1.050,95% 1.029 - 1.071,<0.001)的独立危险因素。多因素logistic回归分析还显示,女性不是接受直接经皮冠状动脉介入治疗的STEMI患者院内死亡(=1.539,95% 0.572 - 4.142,=0.394)和复合终点(=1.563,95% 0.689 - 3.546,=0.285)的独立危险因素,但年龄是接受直接经皮冠状动脉介入治疗的STEMI患者院内死亡(=1.052,95% 1.011 - 1.096,=0.013)和复合终点(=1.042,95% 1.008 - 1.077,=0.016)的独立危险因素。STEMI女性患者院内主要不良心血管和脑血管事件发生率高于男性患者,年龄是STEMI患者院内主要不良心血管和脑血管事件的独立危险因素。

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