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目的探讨老年女性急性ST段抬高型心肌梗死(STEMI)的临床特征及院内死亡危险因素。方法选择清华大学第一附属医院和宣武医院冠心病监护室(CCU)2009—2010年收治的STEMI患者343例,其中女92例,男251例,比较不同性别患者临床资料。结果不同性别患者高血压发生率、2型糖尿病发生率、入院时心率、入院时收缩压、TG、血肌酐、CRP、单支血管病变发生率、双支血管病变发生率、三支血管病变发生率、左主干+右主干+其他病变发生率、并发症发生率比较,差异均无统计学意义(P>0.05);女性患者年龄大于男性患者,非典型症状发生率、血糖、LDL-C、HDL-C、BNP、院内病死率高于男性患者,发病到入住CCU时间长于男性患者,吸烟率、入院时舒张压、LVEF、CK-MB峰值、Killip分级≥Ⅱ级者所占比例、急诊经皮冠状动脉介入治疗(PCI)率、再灌注治疗率低于男性患者(P<0.05)。多因素Logistic回归分析结果显示,女性、BNP水平升高是STEMI患者院内死亡的独立危险因素(P<0.05)。结论老年女性STEMI患者年龄偏大、非典型症状发生率较高、病情较重、误诊误治率及院内病死率较高,女性、BNP水平升高是老年STEMI患者院内死亡的独立危险因素。
Objective To investigate the clinical features and risk factors of nosocomial death in elderly women with acute ST-segment elevation myocardial infarction (STEMI). Methods A total of 343 STEMI patients admitted to the First Affiliated Hospital of Tsinghua University and the Xuanwu Hospital Coronary Care Unit (CCU) from 2009 to 2010 were selected. Among them, 92 were women and 251 were males. The clinical data of patients with different gender were compared. Results The incidence of hypertension, type 2 diabetes mellitus, heart rate at hospital admission, systolic blood pressure at admission, TG, serum creatinine, CRP, incidence of single vessel disease, incidence of double vessel disease and trilateral vessel disease (P> 0.05). Female patients were older than male patients, the incidence of atypical symptoms, blood glucose, LDL-C, HDL-C and BNP, the hospital mortality was higher than that of males, the incidence of CCU was longer than that of males, smoking prevalence, diastolic blood pressure at admission, LVEF, CK-MB peak, Killip grade≥Ⅱ, Percutaneous coronary intervention (PCI) rate and reperfusion rate were lower than those in male patients (P <0.05). Multivariate Logistic regression analysis showed that elevated BNP level in women was an independent risk factor for in-hospital mortality in STEMI patients (P <0.05). Conclusion Elderly women with STEMI are older, have a higher incidence of atypical symptoms, more serious illness, misdiagnosis and misdiagnosis rates and higher hospital mortality rates. Female patients with elevated BNP level are independent risk factors for nosocomial STEMI in elderly patients.