| Background and Objective:Recent years, increasing morbidity of non-ST-segment elevation acute coronary syndrome (NSTEACS) has become one of the most important reasons of death and disability in developed countries and our nation. Because of poor clinical prognosis, patients with non-ST-segment elevation myocardial infarction (NSTEMI) are the high-risk individuals in NSTEACS. Epidemiological studies showed that the morbidity of NSTEMI had been increasing year by year, compared with STEMI. With the current developments of evidence-based medicine and percutaneous coronary intervention, studies have confirmed that compared with 2003, in-hospital mortality in female with NSTEMI decreased by 20% in 2006. However, there was no difference on the 1-year follow-up.Female patients with acute coronary syndrome were treated as special populations in 2007 ACC/AHA unstable angina and NSTEMI treatment guidelines. Symptoms are often not typical in female patients. Therefore, focusing on female patients in this study has more clinical significance.The study aimed to investigate the incidences of cardiovascular adverse events in patients with NSTEMI during hospitalization and long-term follow-up, and assess the long-term prognosis and related factors in female NSTEMI patients.Methods:This was a retrospective and single-center clinical study. The medical documents of those patients stored in the PCI follow-up database and medical records in the First Affiliated Hospital of Dalian Medical University were reviewed in the current study. From January 2002 to December 2013, a total of 2080 patients diagnosed of NSTEMI aged between 26 and 97 were consecutively enrolled in our study including 1317 cases of male patients (63.3%),aged 66.82±12.33, and 763 cases of female ones (36.7%),aged 72.93±8.73. Unified follow-up questionnaire was used to visit the NSTEMI patients after discharge,175 cases were lost to follow-up. The primary endpoints were death from any cause and cardiac death.and the secondary endpoints included death, recurrent infarction, recurrent angina and heart failure.Results:1. Compared with male and female patients, the female patients had more hypertension, diabetes mellitus, older aged (72.93±8.73vs.66.82±12.33, 82.7%vs.62.5%,50.2%vs.31.9%)2. Compared with male patients,the female were less likely to take calcium supplements (30.7% vs.25.3%), diuretics (34.5% vs.22.2%), and the female were more to choose conservative treatment (71.4% vs.52.6%).3. There were total 830 cases of revascularization including 613 cases of male patients (73.9%), and 217 cases of female ones (26.1%). The rates of three-vessel-disease,left main artery, two-vessel-disease, single-vessel-disease has no discrimination; female patients who have received revascularization normal were higher than the male ones.4. There were total 204 cases of cardiac events (19.7%) during hospitalization. The rates of primary endpoint has no discrimination, but that in female patients were higher than the male ones, including recurrent angina (4.3% vs2.8%), heart failure (7.9% vs.5.4%) and recurrent myocardial infarction (3.0% vs.1.9%).5. The long-term follow-up of total 1,701 cases were finished successfully including 623 cases (36.6%) in female. The interval of follow-up was from 1 to 151 months and the median follow-up was 37 months. There was different median follow-up time between the two groups (40 vs. 36 months,P=0.081). The rates of primary endpoint in female patients were higher than male ones(24.6%vs.13.0%),has no discrimination in recurrent angina(19.1%vs.19.2%), has sense in heart failure (10.5% vs.5.8%) and recurrent myocardial infarction (14.4% vs8.7%).6. Single factor analysis showed the rates of the primary endpoint event and secondary one for the female were 1.031 times and 1.254 times that of male ones during hospitalization and 2.033 times and 1.134 times during the follow-up.7.Multivariate COX regression analysis showed that female and admission Killip≥3 were independent risk factors of primary endpoint for NSTEMI patients; revascularization therapy were independent protective factors of primary endpoint during hospitalization.Female and admission Killip≥3 were independent risk factors of composite endpoint; revascularization · therapy were independent protective factors of composite endpoint during hospitalization. Female and admission Killip≥3 were independent risk factors of primary endpoint; revascularization therapy were independent protective factors of primary endpoint during follow-up; admission Killip≥3 were independent risk factors of composite endpoint during follow-up. 8.Acorrding to the age and therapy strategy,separate the two groups to analysis primary endpoint and secondary one.The outcomes shows that in the age less than 65,female patients were worse than male ones in primary endpoint;the other group had no discrimination. The outcomes shows that in conservative treatment,female patients were worse than male ones in primary endpoint;but the had no discrimination in secondary endpoint.Conclusions:(1)The female patients with NSTEMI are older aged and more likely to have hypertension, diabetes and other risk factors and heart function seriously.(2)The female patients with NSTEMI received less evidence-based treatments and reperfusion therapy than male ones. The rates of three-vessel-disease,left main artery, two-vessel-disease, single-vessel-disease has no discrimination; female patients who have received revascularization normal were higher than the male ones.(3) The outcomes during hospitalization were worse than male ones,including recurrent angina,heart failure and recurrent myocardial infarction. Female was independent risk factor of primary endpoint and composite endpoint for NSTEMI patients; revascularization therapy were independent protective factor of primary endpoint and composite endpoint during hospitalization.(4) The outcomes during follow-up were worse than male ones,including primary endpoint and composite endpoint. Female was independent risk factor of primary endpoint for NSTEMI patients; revascularization therapy was independent protective factor of primary endpoint during the follow-up.(5) The outcomes about primary endpoint,which age less than 65, were worse than male ones;the female who choose conservative treatment were worse than male ones in primary endpoint. |
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