经皮冠状动脉介入治疗的3 049例男性和1 878例女性老年患者的临床特征及其性别差异

Clinical features and gender differences in elderly patients undergoing percutaneous coronary intervention: analysis of 3 049 male and 1 878 female patients

摘要:

目的 观察确诊为冠心病并行经皮冠状动脉介入治疗（PCI）的老年患者的临床特征，分析冠心病危险因素在不同性别人群中的差异以及不同性别患者PCI预后的差异。方法 本研究回顾性地分析自2008年7月至2012年11月在沈阳军区总医院年龄＞65岁确诊为冠心病并行PCI治疗的患者4 927例，按性别分为两组，其中男性3049例，女性1878例，统计其临床特征、冠状动脉造影及PCI结果、围术期抗栓治疗药物及其他心血管药物的使用情况、院内主要心脑血管不良事件（MACCE）的发生情况，分析总结两组患者各自的特点及差异。结果 冠心病危险因素中，男性患者吸烟比例和肾功能不全的发病率较女性高（51.5% vs 15.3%，P＜0.01；22.1% vs 15.3%，P＜0.01）；而女性患者体质量指数[（24.8±4.4） vs （24.5±3.7）kg/m2，P＜0.05]和发病年龄更高[（72.6±4.8） vs （72.2±5.4）岁，P＜0.01]，患有高血压、糖尿病的患者比例也较男性高（70.5% vs 60.8%，P＜0.01；32.2% vs 24.9%，P＜0.01）。两组术后MACCE发生率差异无统计学意义，但女性死亡率高于男性（0.6% vs 0.1%，P＜0.01）。结论 在接受PCI的人群中，老年女性较男性拥有更多的冠心病危险因素，且PCI预后也较男性差。

Abstract:

Objective To observe the clinical features of the elderly coronary heart diseases (CHD) patients who had underwent percutaneous coronary intervention (PCI), and analyze the gender differences in risk factors for CHD and the prognosis after PCI. Methods A total of 4 927 elderly CHD patients (＞65 years old) who had underwent PCI in Shenyang General Hospital of Shenyang Military Command from July 2008 to November 2012 were enrolled in this study. There were 3 049 males and 1 878 females in this retrospective study. Clinical features, coronary angiographic results, PCI outcomes, peri-operative medications of antithrombotic agents and other cardiovascular drugs, and incidence of in-hospital major adverse cardiocerebrovascular events (MACCE) were collected and analyzed for gender differences and clinical features. Results Among the risk factors for CHD, the prevalence of smoking and the morbidity of renal dysfunction were significantly higher in the males than in the females (51.5% vs 15.3%, P＜0.01; 22.1% vs 15.3%, P＜0.01). While, the women had higher body mass index (BMI) [(24.8±4.4) vs (24.5±3.7)kg/m2, P＜0.05], older age of onset [(72.6±4.8) vs (72.2±5.4) years, P＜0.01], and higher proportion of morbidities such as hypertension and diabetes (70.5% vs 60.8%, P＜0.01; 32.2% vs 24.9%, P＜0.01) than the men. There was no significant difference in the overall incidence of in-hospital MACCE between the male and female patients. However, the females had significantly higher mortality than the males (0.6% vs 0.1%, P＜0.01). Conclusion The elderly female CHD patients undergoing PCI have severer burden of risk factors and poor prognosis than their male counterparts.