直接经皮冠状动脉介入治疗急性ST段抬高型心肌梗死患者的性别差异

doi:10.3969/j.issn.1000-8535.2021.04.016

广州医药 ›› 2021, Vol. 52 ›› Issue (4): 71-76.DOI: 10.3969/j.issn.1000-8535.2021.04.016

直接经皮冠状动脉介入治疗急性ST段抬高型心肌梗死患者的性别差异

江志羔, 肖俊会, 钟明江, 贺立新, 朱洪海, 杨潜照, 李芳

广州市花都区人民医院心血管内科(广州 510000)

出版日期:2021-07-20 发布日期:2021-11-23
基金资助:
广州市花都区科技计划项目(19-HDWS-059)

Sex difference in acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

JIANG Zhigao, XIAO Junhui, ZHONG Mingjiang, HE Lixin, ZHU Honghai, YANG Qianzhao, LI Fang

Department of Cardiovascular, Guangzhou Huadu District People's Hospital, Guangzhou 510000, China

Online:2021-07-20 Published:2021-11-23

摘要/Abstract

摘要： 目的分析广州北部区域某胸痛中心不同性别的急性ST段抬高型心肌梗死患者直接经皮冠状动脉介入治疗的结果。方法纳入广州市花都区人民医院2016年12月—2020年1月期间接受直接经皮冠状动脉介入治疗的急性ST段抬高型心肌梗死患者。按照不同的性别,评估患者的危险因素、治疗时限性和主要心血管不良事件情况。结果入选389名患者,73名(18.8%)为女性。和男性患者对比,女性患者年龄更大(69.3±10.8岁vs 55.8±13.1 岁,P＜0.05),具有更高比例的2型糖尿病(26.0% vs 17.7%,P＜0.05)、高血压病(58.9.0% vs 43.0%,P＜0.05)病史。女性患者的症状-首次医疗接触时间和总缺血时间均长于男性患者(分别为229.2 min vs 174.5 min,P＜0.05;424.9 min vs 317.4 min,P＜0.05),PCI术中出现慢血流/无复流的比例更高(26.0% vs 16.5%,P＜0.05)。女性患者主要住院心血管事件风险更高(11.0% vs 4.4%, P＜0.05),其中院内死亡率(4.1% vs 1.6%, P＜0.05)。女性患者在院期间发生心衰及心源性休克的比例更高(分别为34.2% vs 21.2%,P＜0.05; 30.1% vs 18.7%,P＜0.05)。结论在行急诊介入治疗的急性ST段抬高型心肌梗死患者中,女性患者预后差于男性,具有更高的心血管事件风险,死亡率更高。

关键词: 急性ST段抬高型心肌梗死, 直接PCI, 性别差异, 总缺血时间

Abstract: Objective We investigated sex-based outcomes after primary percutaneous coronary intervention (PPCI) in patients with acute ST-segment elevation myocardial infarction (STEMI) in a chest pain center of northern Guangzhou. Methods From December 2016 to January 2020, consecutive STEMI patients who underwent PPCI in Guangzhou Huadu District People's Hospital were recruited. Risk factors, time variables, and major cardiovascular adverse events (MACE) were assessed according to gender. Results A total of 389 patients were enrolled,with 73(18.8%)women. Compared to men, women patients presented higher risk profiles with old age(69.3±10.8 years vs 55.8±13.1 years,P＜0.05),diabetes (26.0% vs 17.7%,P＜0.05), hypertension (58.9.0% vs 43.0%,P＜0.05).Women had longer symptom onset to first medical contact time and total ischemic time than men had(229.2min vs 174.5min,P＜0.05;424.9min vs 317.4min,P＜0.05).During PCI procedure,women presented higher ratio of slow flow/no reflow(26.0% vs 16.5%,P＜0.05).Women had increased major adverse events(11.0% vs 4.4%, P＜0.05), and higher in-hospital mortality(4.1% vs 1.6%, P＜0.05).Women presented more heart failure incidence (34.2% vs 21.2%,P＜0.05),and cardiac shock incidence(30.1% vs 18.7%,P＜0.05). Conclusion Women with acute STEMI who underwent PPCI had worse outcomes compared to men.They had higher MACE and in-hospital mortality.

Key words: Acute ST-segment elevation myocardial infarction, Primary PCI, Sex difference, Total ischemic time

江志羔, 肖俊会, 钟明江, 贺立新, 朱洪海, 杨潜照, 李芳. 直接经皮冠状动脉介入治疗急性ST段抬高型心肌梗死患者的性别差异[J]. 广州医药, 2021, 52(4): 71-76.

JIANG Zhigao, XIAO Junhui, ZHONG Mingjiang, HE Lixin, ZHU Honghai, YANG Qianzhao, LI Fang. Sex difference in acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention[J]. Guangzhou Medical Journal, 2021, 52(4): 71-76.

参考文献

[1] MEHTA L S, BECKIE T M, DEVON H A, et al. Acute myocardial infarction in women: a scientific statement from the American Heart Association[J]. Circulation, 2016,133(9):916-947.
[2] CENKO E, van der SCHAAR M, YOON J, et al. Sex-related differences in heart failure after ST-segment elevation myocardial infarction[J]. J Am Coll Cardiol,2019,74(19):2379-2389.
[3] BUGIARDINI R, RICCI B, CENKO E, et al. Delayed care and mortality among women and men with myocar-dial infarction[J]. J Am Heart Assoc, 2017,6(8):e005968.
[4] LEIFHEIT-LIMSON E C, D'ONOFRIO G, DANESHVAR M, et al. Sex differences in cardiac risk factors, perceived risk, and health care provider discussion of risk and risk modification among young patients with acute myocardial infarction: the VIRGO study [J]. J Am Coll Cardiol, 2015,66(18):1949-1957.
[5] IBANEZ B, JAMES S, AGEWALL S, et al. 2017 ESC guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: the task force for the management of acute myocardial infarction in patients presenting with ST-segment elevation of the European Society of Cardiology (ESC) [J].Eur Heart J, 2018,39(2):119-177.
[6] 中华医学会心血管病学分会, 中华心血管病杂志编辑委员会. 急性ST段抬高型心肌梗死诊断和治疗指南 [J].中华心血管病杂志,2015,45(5): 380-393.
[7] HICKS K A,STOCKBRIDGE N L, TARGUM S L, et al. Bleeding academic research consortium consensus report: the food and drug administration perspective [J]. Circulation, 2011, 123(23):2664-2665.
[8] 赵延延,杨进刚,许浩博,等. 中国医院急性ST 段抬高型心肌梗死医疗质量与住院死亡率的相关性分析[J].中国循环杂志,2019, 34 (5): 437-443.
[9] SHEHAB A, BHAGAVATHULA A S, ALHABIB K F, et al. Age-related sex differences in clinical presentation, management, and outcomes in ST-segment-elevation myocardial infarction: pooled analysis of 15 532 patients from 7 Arabian Gulf registries [J]. J Am Heart Assoc,2020,9(4):e013880.

直接经皮冠状动脉介入治疗急性ST段抬高型心肌梗死患者的性别差异

Sex difference in acute ST-segment elevation myocardial infarction treated with primary percutaneous coronary intervention

PDF

可视化

摘要/Abstract

引用本文

使用本文

参考文献

相关文章 0

编辑推荐

Metrics

本文评价