| Objective:To investigate the clinical characteristics and the prognostic risk factors of different gender patients with acute coronary syndromes(ACS)Methods:All ACS patients who were admitted to the Departmalet of Cardiology of the Affiliated Hospital of Chengde Medical College from April 2014 to October 2015 were enrolled in the study.All of the 845 patients were also followed up for percutaneous coronary intervention(PCI)who were eligible for the inclusion criteria were consecutively included in the study.ALL patients were divided into two groups: female group and male group,respectively 207 cases(24%)and 638 cases(76%).This study collected all the demographic characteristics,clinical symptoms,treatmalet programs and other information of patients,all patients were regularly followed up.According to whether experience the MACE,All patients were divided into MACE group(159,18.8%)and Without MACE group(686,18.8%).The variables of P-values<0.1 in the MACE group and the non-MACE group,were selected into the COX proportional risk regression model assessing the risk factors of long-term prognosis of patients between the sexes with ACS.P-values<0.05 were considered significant.Results:1.Females were older than the males(60.32 ± 9.814 vs 55.76 ± 10.275,P<0.001).Patients of ACS over 65 years were predominantly female [30.9%(64/207)vs 18.3%(117/638),P<0.001].The ratio of male body mass index(BMI)≥28 kg/ m2 was higher than that of the female [21%(72/638 vs 12%(15/207),P < 0.05].Females were more common in the NSTEMI/UA,(P<0.05)and the patients with STEMI were predominantly males [43.1%(275/638)vs 31.4%(65/207),P<0.05].The proportion of females with Killip grade 3~4 was higher than that of males [21.3%(19/207)vs 10.6%(38/638),P<0.05].Compared with male,female with ACS were more complicated with nontypical pain [55.6%(115/207)vs 47.5%(303/638),P<0.05].2.Compared with the male group,the female group had higher incidence of hypertension [70%(145/207)vs 52.5%(335/638),P<0.001],diabetes [32.4%(67/207)vs 21.2%(P<0.05)],dyslipidemia [82.8%(169/207)vs 71.1%(447/638),P<0.05].There were 90 males(14.3%)and 54 females(26.5%)in the patients with hypercholesterolemia,the difference was statistically significant(P < 0.001);There were 310 males(49.3%)and 111 females(54.4%)with hypertriglyceridemia,but the difference was not statistically significant;The proportion of abnormality of HDL [47.1% vs 32.6% ] and LDL [20.1%(41/207)vs 10%(63/638),P<0.001] in females were significantly higher than that in man.The proportion of smoking in male group was significantly higher than that in female group [57.2%(365/638)vs 5.8%(12/207),P<0.05],and with more history of myocardial infarction [12.2%(78/638)vs 4.8%(10/207),P < 0.05].During the stay in hospital,the incidence of hypokalemia in the female group was higher than that in the male group(P<0.05).3.Femals have similar prevalence of single-vessel disease,double-vessle disease and the rates of multivessel disease(P>0.05).Comparison of the number of stents: the ratio of female group using two or more stents were higher than that in male group,but the proportion of thrombus aspiration or balloon dilatation was higher in male than that in female,but there was no statistically significant difference between the two groups(P<0.05).4.The proportion of intravenous thrombolytic therapy in male group was higher than that in female group [7.8%(50/638)vs 1.4%(3/207),P<0.05].Compared with females,males were more likely to choose the primary PCI(P < 0.05).Secondary prevention comparison: the prescription rates of clopidogrel,heparin and tirofiban in the male group were higher than those in the female group within 24 hours of admission(P<0.05),but the prescription rates of aspirin,statin,β-blocker and ACEI / ARB between the two groups was not statistically significant.The prescription rates of the discharged drug,such as aspirin,clopidogrel,statin,β-blockers and ACEI / ARB,between the two groups was not statistically significant.5.The comparison of the delayed treatment between the two groups: The median time from the onset of the symptoms with ACS to the first medicine contact: the treatment proportion in male group within 24 hours [14.6%(93/638)vs 7.7%(16/207)],24 h to 1 month [25.9%(165/638)vs 21.7%(45/207)],1 month to 6 months[15.7%(100/638)vs 11.6%(24/207],were significantly higher than female group;however,the treatment rate in females within 6 months to1 year [8.2%(17/207)vs 4.4%(28/638)],and above 1year [50.7%(105/207)vs 39.5%(252/638)],were significantly lower than males(P<0.05).The median time from the exacerbation of ACS to the treatment of female patients were significantly higher than men,168 h vs 96 h,(P<0.05),respectively.6.Follow-up results: The median follow-up time in this study was 337 days.Female group(207 cases)died 1 case,the occurrence of major cardiovascular adverse events(MACE)51 cases;male group(638 cases)died 10 cases,there were 108 cases of MACE.There was no significant difference in mortality between the two groups.MACE incidence rate,female group was higher than the male group,P<0.05.Secondary end points: The proportion of females with angina after PCI was higher than that of the male[40.4%(80/207)vs24.3%(148/638),P<0.001].Cardiac arrest,cardiogenic shock,PCI postoperative complications,the incidence of contrast nephropathy,the difference between the two groups was not statistically significant.7.By drawing the survival curves and conducting Log-rank test for both female and male group,the difference between the two groups was proved as being statistically significant(P=0.011).The variables of P<0.1 in the MACE group and the non-MACE group,were selected into the COX proportional risk regression model.The variables in the model were: female,hypertension,treatment in 24 hours,malignant arrhythmia,WBC>10×109,complete right bundle branch block(CRBBB),NYHA II~VI and so on.Among them,female,hypertension,malignant arrhythmia,elevated white blood cells,CRBBB were independent risk factors for ACS with poor prognosis.The risk ratio(HR)was 1.544,1.458,2.400,1.581 and 3.046 respectively;treatmalet in 24 hours is the prognosis protective factor of ACS,the HR is 0.699(all P<0.05).Conclusion:In the patients of ACS,females are older,combined with more metabolic diseases,such as high blood pressure,diabetes,dyslipidemia and so on.With the increase of age,the protective effect of estrogen in female patients is gradually weakened,the age of onset of ACS is generally greater than that of male.Although the social status of female patients,the degree of education gradually increased,but the proportion of delayed treatment was still significantly higher than male,and timely treatmalet within 24 h is independent protective factors influencing long-term prognosis of ACS.Female,hypertension,malignant arrhythmia,WBC>10×109,CRBBB are independent risk factors influencing long-term prognosis of ACS,the secondary prevention of ACS should be given high priority. |
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