Analysis On The Clinical Features Of 79 Women With Acute Myocardial Infarction

Background and ObjectiveIn many countries, the morbidity and mortality of coronary heart disease are on top of the list of diseases. As the recognization of pathogenesis and risk factors on coronary heart disease have been gradually deepen and the prevention and treatment have been improved, coronary heart disease morbidity and mortality showed a downward trend in year-on-year. However, among women, such downward trend was less obvious than man, even a downward trend was not observed. At the beginning, many people think this phenomenon should be attributed to hypoperfusion of the women's health, women's long pre-hospital delay and other non-disease factors. However, in-depth study found that female patients with coronary heart disease have many different characteristics from men, such as female patients with risk factors like diabetes are considered as high percentage, lack of typical clinical chest pain, and complex symptoms, the false positive rate and false-negative rates of inspections related to coronary artery lesions are relatively high, often misdiagnosed or missed, accepting the treatment of myocardial reperfusion has such as bad effects. Since 1970's, study with large sample started to include women , a series of clinical research included women groups have started to make. realization of coronary heart disease in women has been greatly improved. The purpose of this study is that from discussing clinical features of female patients with AMI in order to provide a basis of treatment and prevention for women patients with AMI. Data and MethodsRetrospective analysis compared clinical feature between 79 female patients and 144 male patients during the same period with acute myocardial infarction hospitalized in First Hospital of Jilin University between January 2007 and December 2008. Inclusion criteria: (1) there is a typical ischemic chest pain symptoms. (2) related ECG leads can be observed ST-segment elevation, and the existence of dynamic evolution. (3) enzyme and markers of myocardial injury (cardiac troponin I) is more than two times of the normal , and the existence of dynamic changes. (4) the coronary angiography confirmed that a one or more coronary artery are total occlusion. With (4) and two or more than two cases in (1) - (3) can be selected. Patients with a detailed record of sex, age, smoking history, drinking history, past medical history, Seasonal incidence of clinical symptoms, laboratory tests, ECG and cardiac color Doppler ultrasound examination, the results of coronary angiography, clinical diagnosis, hospital of complications and death and so on. Seasonal incidence of patients is determined in accordance with the time of hospital; statistical standards of high blood pressure and diabetes are that the patients diagnosed before or diagnosed hypertension and diabetes in hospital counted as positive, more than the total negative; place of residence, smoking history, alcohol history, previous history of chest pain in patients are described respectively positive and negative, in accordance with chief complaint. Statistical methods:the measurement data expressed as mean±standard deviation if measurement data was normal distribution and applied t test, Analysis of data applied rank sum test if the measurement data was not normal distribution,and expressed as the median±quartile interval; The count data applied chi-square test; comparison of groups use single-factor analysis of variance.ResultsCompared with men, women with acute myocardial infarction had following clinical features:1. The age of women with AMI were older than that of men, more than 55 years of age were common (70.9% vs 40.3%, p <0.01);2. Significantly lower rate of smoking; significantly lower rate of drinking. (29.1% vs 72.9%, p <0.01; 2.5% vs 24.3%, p <0.01);3. Higher rate of hypertension, diabetes, dyslipidemia (54.4% vs 36.8%, 34.2% vs 19.4%, 53.2% vs 36.8%, p <0.05);4. The higher incidence of gastrointestinal symptoms as the main performance of nausea and vomiting (43.0% vs 24.3%, p <0.05; 40.5% vs 16.7%, p <0.01);5. A lesser extent of elevated CK and AST [(976.5±1719.7)U/L vs(1548.6±2636.3)U / L and (113.6±136.5)U/L v(s151.6±181.1)U/L, p <0.05];6. Although compared with the control group ,ST-segment elevation, pathologic Q wave in the ECG had no difference, but the T-wave inversion in ECG as a performance was significantly higher (54.4% vs 33.3%, p <0.01);7. Increased left ventricular diameter and aneurysm in the color Doppler of heart had higher incidence (62.0% vs 40.4%, p <0.01; 10.1% vs 1.4%, p <0.01);8. The site of criminal vascular had no significant differences in gender. But still give us some tips: the lower ratio of stenosis in LAD and LCX, and the emergence of stenosis in RCA and the combined multivessel disease were more than men. Conclusions and SignificanceThrough this research, we found that:1. The age of female patients with acute myocardial infarction were older. Although bad habits such as smoking and drinking were significantly less than men, but the rate of hypertension, diabetes, dyslipidemia were higher than men.Therefore, in quitting smoking and limiting alcohol, a positive control of hypertension, diabetes, dyslipidemia had great significance for the prevention of women with acute myocardial infarction.2. When female patients with acute myocardial infarction onset, the gastrointestinal symptoms such as nausea, vomiting were more easily occured, so AMI were often misdiagnosed as gastrointestinal diseases, and should be sufficient knowledge and vigilance.3. Because the rate of elevated CK and AST in female patients was significantly lower than the control group rate, and the performance as T-wave inversion in ECG was higher than that of the control, therefore, misdiagnosis may occur, We should be carefully carried out the dynamic observation of CK, AST, and T-wave.4. Women with AMI had higher incidence of increased left ventricular diameter and aneurysm in the color Doppler of heart. This showed that women had a higher incidence of cardiac remodeling.So we should be closely observed cardiac function and carried out treatment on improvement and reverse remodeling in cardiac as early as possible.