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背景:已有研究表明冠心病存在某些明显的性别差异,但是,性别是否影响其治疗结局尚不清楚。目的:分析冠状动脉支架置入后的长期随访结果,明确其性别差异。设计、时间及地点:前瞻性随访,2004-01/2005-12在武汉亚洲心脏病医院。对象:冠状动脉支架置入治疗267例患者,完成3年的临床随访。女52例,男215例;平均年龄(59.4±7.5)岁。方法:按标准置入冠状动脉支架,以残余狭窄<30%,远端前向血流为TIMI3级为经皮冠状动脉介入治疗成功。定期门诊随访,分别于置入后6个月进行电话随访、每年进行问卷随访。平均随访时间(20±7)个月。主要观察指标:对比分析52例女性与215例男性冠心病的临床特点、冠状动脉造影所见和冠状动脉支架置入后3年随访结果。结果:与男性相比,女性平均年龄大,收缩压高,胆固醇高(P<0.001);心胸比大(P<0.05);有高血压病史的比例高(P<0.001);伴有非心血管疾病的比例高(P<0.001);有心肌梗死病史的比例低(P<0.01);有吸烟史的比例低(P<0.001)。在随访期内,两组在支架置入后死亡、主要心血管不良事件、复发的典型心绞痛方面差异无显著性;患者自我评估的症状缓解比例和生活质量改善的比例在男、女性之间差异无显著性。多因素分析显示女性不是冠状动脉支架置入后死亡、非致死性心肌梗死和复发典型心绞痛复合终点的预测因子(OR0.819,95%CI0.41to1.79)。结论:女性冠心病患者的年龄较大,并存疾病较多。冠状动脉支架置入后长期随访疗效较好,且治疗结局与性别无关。
Background: Previous studies have shown that there are some obvious gender differences in coronary heart disease, but it is unclear whether gender affects its treatment outcome. OBJECTIVE: To analyze the long-term follow-up results after coronary stent implantation and clarify the gender differences. DESIGN, TIME AND SETTING: A prospective follow-up was performed at the Asian Heart Disease Hospital in Wuhan from January 2004 to December 2005. PARTICIPANTS: A total of 267 patients undergoing coronary stenting were followed up for 3 years. There were 52 males and 215 females, with an average age of (59.4 ± 7.5) years. Methods: According to the standard coronary stent implantation, the residual stenosis <30%, distal anterior flow TIMI grade 3 for the success of percutaneous coronary intervention. Regular outpatient follow-up, respectively, 6 months after placement for telephone follow-up, annual questionnaire follow-up. The mean follow-up time was (20 ± 7) months. MAIN OUTCOME MEASURES: The clinical characteristics of 52 women and 215 men with coronary heart disease were compared and analyzed. Results of coronary angiography and 3-year follow-up after coronary stent implantation were compared. Results: Compared with men, the average age of women, high systolic blood pressure, high cholesterol (P <0.001); cardiothoracic ratio (P <0.05); had a high proportion of hypertensive history (P <0.001) There was a high proportion of vascular disease (P <0.001), a lower prevalence of MI (P <0.01) and a lower rate of smoking (P <0.001). During the follow-up period, there was no significant difference between the two groups in terms of death after stent implantation, major cardiovascular adverse events, and typical angina relapse. The proportion of patients with self-assessment of symptom relief and quality of life improved in men and women No significant. Multivariate analysis showed that women were not predictor of death, non-fatal myocardial infarction, and composite endpoint of recurrent angina pectoris after coronary stenting (OR 0.891, 95% CI 0.41 to 1.79). Conclusion: Women with coronary heart disease are older and have more diseases. Long-term follow-up after coronary stent implantation is effective, and the treatment outcome has nothing to do with gender.