Objective: 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). Methods: 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. Results: 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, P<0.001). Compared with male patients, less female patients received primary percutaneous coronary intervention (50.9%(144/283) vs. 70.9%(581/819), P<0.001), had higher rates of in hospital death(10.6%(30/283)vs. 6.0%(36/819), P<0.001) and composite endpoint(14.1%(40/283)vs. 7.0%(57/819), P<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 P>0.05). Among STEMI patients aged ≥60 years, female patients had higher in-hospital mortality (12.9%(29/225)vs. 7.9%(30/382), P<0.001), and there was no difference on composite endpoint between female and male patients (16.4%(37/225)vs. 11.0%(42/382), P=0.054). Multivariate logistic regression analysis showed that female gender was not the independent risk factor of in-hospital death(OR=1.029, 95%CI 0.564-1.877, P=0.926) and composite end point(OR=1.593, 95%CI 0.989-2.566, P=0.055), but age was the independent risk factor of in-hospital death(OR=1.065, 95%CI 1.037-1.094, P<0.001) and composite end point(OR=1.050, 95%CI 1.029-1.071, P<0.001)in STEMI patients. Multivariate logistic regression analysis also showed that female was not the independent risk factor of in-hospital death(OR=1.539, 95%CI 0.572-4.142, P=0.394) and composite end point(OR=1.563, 95%CI 0.689-3.546, P=0.285), but age was the independent risk factor of in-hospital death(OR=1.052, 95%CI 1.011-1.096, P=0.013) and composite end point(OR=1.042, 95%CI 1.008-1.077, P=0.016)in STEMI patients received primary percutaneous coronary intervention. Conclusion: 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.
目的： 探讨性别和年龄对急性ST段抬高型心肌梗死(STEMI)患者住院期间主要不良心脑血管事件的影响。 方法： 回顾性分析2001年1月至2010年12月在大连医科大学附属第一医院心内科住院的1 102例STEMI患者的临床资料。研究的主要终点为住院期间任何原因的死亡；次要终点为复合终点事件，包括住院期间死亡、新发卒中或再发心肌梗死。采用多因素logistic回归分析住院期间死亡和复合终点事件的危险因素。 结果： 女性STEMI患者占25.7%(283/1 102)，女性患者的年龄大于男性患者[(68.7±11.2)岁比(59.2±12.5)岁，P<0.001]。女性患者接受直接经皮冠状动脉介入治疗(PCI)的比例低于男性患者[50.9%(144/283)比70.9%(581/819)，P<0.001]。女性患者住院期间死亡[10.6%(30/283)比6.0%(36/819)，P<0.001]和发生复合终点事件[14.1%(40/283)比7.0%(57/819)，P<0.001]比例均高于男性患者。在<60岁的患者中，女性与男性之间的住院期间死亡[1.7%(1/58)比1.4%(6/437)]和发生复合终点事件[3.6%(3/58)比3.4%(15/437)]比例差异均无统计学意义(P均>0.05)；在≥60岁的患者中，女性住院期间死亡的比例高于男性[12.9%(29/225)比7.9%(30/382)，P<0.001]，女性与男性之间发生复合终点事件的比例差异无统计学意义[16.4%(37/225)比11.0%(42/382)，P＝0.054]。多因素logistic回归分析显示，女性不是STEMI患者住院期间死亡(OR＝1.029, 95%CI 0.564～1.877，P＝0.926)和复合终点事件(OR＝1.593，95%CI 0.989～2.566，P＝0.055)的独立危险因素，而年龄是STEMI患者住院期间死亡(OR＝1.065, 95%CI 1.037～1.094，P<0.001)和复合终点事件(OR＝1.050，95%CI 1.029～1.071，P<0.001)的独立危险因素；在接受直接PCI的STEMI患者中，女性不是住院期间死亡(OR＝1.539, 95%CI 0.572～4.142，P＝0.394)和复合终点事件(OR＝1.563，95%CI 0.689～3.546，P＝0.285)的独立危险因素，而年龄是住院期间死亡(OR＝1.052, 95%CI 1.011～1.096, P＝0.013)和复合终点事件(OR＝1.042, 95%CI 1.008～1.077, P＝0.016)的独立危险因素。 结论： 在住院期间，女性STEMI患者主要不良心脑血管事件发生率高于男性；年龄是STEMI患者住院期间发生主要不良心脑血管事件的独立危险因素。.
Keywords: Age factors; Death; Myocardial infarction; Sex factors.