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目的探讨性别对接受急诊冠脉介入治疗(PPCI)的急性ST段抬高型心肌梗死(STEMI)患者院内死亡发生率的影响。方法选取全军心血管介入诊疗管理系统中接受PPCI治疗的8878例急性STEMI患者的临床资料,男性7137例,女性1741例,对其数据进行比对,分析性别差异对院内死亡率的影响。采用倾向评分校正不同性别患者年龄及合并症的基线资料差异后,进一步分析性别差异对院内死亡率的影响。结果与男性患者比较,女性患者的平均年龄较大(P<0.05),合并患有高血压、糖尿病、脑血管病、心功能不全的比例较高(P<0.05),既往接受介入治疗的比例较低(P<0.05),三支血管病变的比例较高(P<0.05),血管开通时间较晚(P<0.05),术后发生出血事件的比例较高(P<0.05),且院内死亡率明显高于男性患者(4.4%vs 2.4%,P<0.001)。采用倾向评分配对方法校正不同性别患者的年龄及合并症数据资料后,不同性别患者的院内死亡率差异消失(男性vs女性:4.0%vs 4.4%,P=0.610)。多因素分析进一步证实,女性并不是接受PPCI治疗的急性STEMI患者院内死亡的独立危险因素,年龄、心功能不全、慢血流、术后出血是接受PPCI治疗的急性STEMI患者院内死亡的独立危险因素。结论女性可能不是接受PPCI治疗的急性STEMI患者院内死亡的独立危险因素,但这一结论还需要大规模研究进一步证实。
Objective To investigate the effect of gender on the incidence of nosocomial death in acute ST-segment elevation myocardial infarction (STEMI) undergoing emergency PCI (PPCI). Methods The clinical data of 8878 acute STEMI patients treated with PPCI in the military cardiovascular interventional management system were selected. The data of 7137 males and 1741 females were compared and their data were compared to analyze the influence of gender differences on in-hospital mortality. The use of propensity score correction of gender differences in patients with age and comorbid baseline differences in the data to further analyze the gender differences in the impact of hospital mortality. Results The average age of female patients was significantly higher than that of male patients (P <0.05). The proportion of patients with hypertension, diabetes, cerebrovascular disease and heart failure was significantly higher than that of male patients (P <0.05) (P <0.05), the proportion of three vessel disease was higher (P <0.05), the time of vessel opening was later (P <0.05), and the proportion of postoperative bleeding was higher (P <0.05) Mortality was significantly higher in men than in men (4.4% vs 2.4%, P <0.001). Differences in hospital mortality disappeared between men and women (4.0 vs 4.4% vs. P = 0.610) using the propensity score method to correct age and comorbidity data for patients of different genders. Multivariate analysis further confirmed that women were not independent risk factors for nosocomial mortality in patients with acute STEMI who underwent PPCI and that age, cardiac insufficiency, slow blood flow, and postoperative bleeding were independent risk factors for in-hospital mortality in PPCI-treated acute STEMI patients . Conclusion Women may not be independent risk factors for nosocomial death in acute STEMI patients treated with PPCI, but this conclusion still needs further confirmation in large-scale studies.