2019 年第 6 期 第 14 卷

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

Gender differences in hospitalized patients with acute myocardial infarction and risk factors of in-hospital death after percutaneous coronary intervention

作者：乔曼丽毕齐

英文作者：

单位：100029首都医科大学附属北京安贞医院全科医疗科（乔曼丽），神经内科（毕齐）

英文单位：

关键词：急性心肌梗死；经皮冠状动脉介入术；性别差异

英文关键词：

• 摘要：

• 【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。

• 【Abstract】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 1st 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.