| 胡海英,范晓涌,王世明,张玉峰,张 钊,郑彬彬.不同年龄女性急性ST段抬高型心肌梗死患者冠状动脉病变特点、PPCI治疗临床疗效的差异及院内死亡的危险因素分析[J].,2023,(9):1741-1746 |
| 不同年龄女性急性ST段抬高型心肌梗死患者冠状动脉病变特点、PPCI治疗临床疗效的差异及院内死亡的危险因素分析 |
| Characteristics of Coronary Artery Disease, the Difference of Clinical Efficacy of PPCI Treatment and the Risk Factors Analysis of In-Hospital Death in Female Patients with Acute ST-Segment Elevation Myocardial Infarction of Different Ages |
| 投稿时间：2022-09-23 修订日期：2022-10-18 |
| DOI：10.13241/j.cnki.pmb.2023.09.028 |
| 中文关键词: 年龄 女性 急性ST段抬高型心肌梗死 冠状动脉 PPCI 院内死亡 危险因素 |
| 英文关键词: Age Female Acute ST segment elevation myocardial infarction Coronary artery PPCI In-hospital death Risk factors |
| 基金项目:兰州市科技发展指导性课题项目（2019-ZD-1）；甘肃省卫生行业科研项目（GSWSKY2017-17） |
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| 摘要 目的：分析不同年龄女性急性ST段抬高型心肌梗死（STEMI）患者冠状动脉病变特点、经急诊经皮冠状动脉介入（PPCI）治疗后的临床疗效差异及院内死亡的危险因素。方法：选取2018年1月~2022年3月期间在我院接受PPCI治疗的女性STEMI患者408例，根据患者不同的发病年龄将其分为A组（年龄≤65岁，n=161）与B组（年龄>65岁，n=247）。对比不同的发病年龄PPCI冠状动脉病变特点、治疗后的临床疗效差异及院内不良事件发生情况。单因素和多因素Logistic回归分析女性STEMI患者院内死亡的危险因素。结果：A组、B组的病变血管数量、钙化病变组间对比有统计学差异（P<0.05）。A组、B组的病变血管部位、术前TIMI血流分级、分叉病变组间对比无统计学差异（P>0.05）。两组主动脉内囊反搏术比例组间对比未见明显差异（P>0.05），B组症状发生到血管开通时间（S-to-D）、门-球囊扩张时间（D-to-B）时间长于A组（P<0.05）。两组术中死亡、支架内血栓、BARC3~5级出血比例组间对比无统计学差异（P>0.05）。B组术后死亡的发生率低于A组（P<0.05）。根据患者不同的预后结局分为存活组（n=369）和死亡组（n=39）。单因素分析结果显示女性STEMI患者院内死亡与年龄、糖尿病、体质量指数（BMI）、Killip心功能分级、术前TIMI血流分级、术后TIMI血流分级、住院天数、S-to-D时间、D-to-B时间、收缩压（SBP）、舒张压（DBP）、白细胞计数（WBC）、中性粒细胞、血小板体积分布宽度（PDW）、左心室射血分数（LVEF）、肌酸激酶同工酶（CK-MB）有关（P<0.05）。多因素Logistic回归分析，结果显示年龄偏大、LVEF偏低、CK-MB偏高、术后TIMI血流分级0~I级、S-to-D时间偏长是女性STEMI患者院内死亡的危险因素（P<0.05）。结论：不同年龄女性STEMI患者冠状动脉病变特点、且PPCI 的治疗效果存在一定的差异。此外，年龄偏大、LVEF偏低、CK-MB偏高、术后TIMI血流分级0~I级、S-to-D时间偏长是女性STEMI患者院内死亡的危险因素。 |
| 英文摘要: |
| ABSTRACT Objective: To analyze the characteristics of coronary artery disease, the difference of the clinical efficacy of primary percutaneous coronary intervention (PPCI) treatment and the risk factors of in-hospital death in female patients with acute ST-segment elevation myocardial infarction (STEMI) of different ages. Methods: 408 female patients with STEMI who received PPCI treatment in our hospital from January 2018 to March 2022 were selected, and they were divided into group A (age less than or equal to 65 years, n=161) and group B (age greater than 65 years, n=247) according to the different onset ages. The characteristics of PPCI coronary artery lesions at different onset ages, the differences in clinical efficacy after treatment, and the incidence of in-hospital adverse events were compared. Univariate and multivariate Logistic regression analysis were used to analyze the risk factors of in-hospital mortality in female patients with STEMI. Results: There were significant differences in the number of lesions vessels and calcified lesions between group A and group B (P<0.05). There were no significant differences in the location of lesions vessels, preoperative TIMI blood flow grade, and bifurcation lesions between group A and group B (P>0.05). There was no significant difference in the proportion of intra-aortic pump between the two groups (P>0.05). The time from symptom onset to vessel opening (S-to-D) and portal-balloon dilatation (D-to-B) in the group B were longer than those in the group A (P<0.05). There was no significant difference in the proportion of intraoperative death, stent thrombosis and BARC3-5 bleeding between the two groups (P>0.05). The incidence of postoperative death in the group B was lower than that in the group A (P<0.05). Patients were divided into survival group (n=369) and death group (n=39) according to different prognostic outcomes. Univariate analysis showed that female patients with STEMI of in-hospital death were related to age, diabetes, body mass index (BMI), Killip cardiac function grade, preoperative TIMI blood flow grade, postoperative TIMI blood flow grade, hospitalization days, S-to-D time, D-to-B time, systolic blood pressure (SBP), diastolic blood pressure (DBP), white blood cell count (WBC), neutrophil, platelet volume distribution width (PDW), left ventricular ejection fraction (LVEF) and creatine kinase isoenzyme (CK-MB) (P<0.05). Multivariate Logistic regression analysis showed that older age, lower LVEF, higher CK-MB, postoperative TIMI blood flow grade 0~I, and longer S-to-D time were risk factors for female patients with STEMI of in-hospital death (P<0.05). Conclusion: There are certain differences in the characteristics of coronary artery lesions and the therapeutic efficacy of PPCI in female patients with STEMI of different ages. In addition, older age, lower LVEF, higher CK-MB, postoperative TIMI grade 0~I, and longer S-to-D time are risk factors for female patients with STEMI of in-hospital death. |
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