Clinical Characteristics Of Female Patients With St Segment Elevation Myocardial Infarction

Objective:To investigate the clinical characteristics of female patients with acute ST-segment elevation myocardial infarction.Methods:The data of patients with STEMI diagnosed in the Department of Cardiology of Beijing Hospital from January 2014 to January 2019 were collected in the inpatient medical record system of Beijing Hospital.It is divided into female group and male group according to sex.The baseline data,hematological examination,clinical manifestations,characteristics of coronary artery disease and drug use during hospitalization(including anticoagulant,antiplatelet,statins,ACEI/ARB,? receptor blockers,etc.),cardiac function indexes(including peak BNP during hospitalization,Killip classification of cardiac function,LVEF measured by cardiac color Doppler ultrasound),adverse events during hospitalization(including cardiogenic shock,recurrent myocardial infarction,gastrointestinal bleeding,acute renal failure,Malignant arrhythmia,cardiac arrest,stent thrombus,mechanical complications,cardiogenic death)were analyzed retrospectively.The effects of gender on STEMI were compared.Results:A total of 102 female patients who met the inclusion criteria were selected as the study group and 242 male patients in the same period as the control group in this study.The age of onset of STEMI in women is older than that in men,74±11.11 vs 61±11.6 years old,p<0.001.The proportion of hypertension in female group(73.5%vs 59.1%,p=0.011),history of heart failure(3.9%vs 0.4%,p=0.029),chronic kidney disease(12.7%vs 4.1%,p=0.004)were higher than those in male group.There were no significant differences in the proportion of diabetes mellitus(40.2%vs 32.6%),dyslipidemia(53.9%vs 57.9%)and old myocardial infarction(5.9%vs 5.8%)compared with male(p>0.05).In the female group,the proportion of smoking(16.7%vs 66.6%,p<0.001),BMI(24.42 ±3.94 vs 25.42±3.01kg/m2,p=0.035),serum creatinine(68(62,98.5)vs77(67,90)umol/l,p<0.001),the peak value of TNI(30.7(10.64,48.77)vs 37.96(11.9,81)ng/ml,p=0.026)were lower than those of male.and the level of HDL-C(1.03(0.945,1.950)vs 0.98(0.845,1.08)mmol/l,.P<0.001)was higher than that in male group.There were no significant differences in fasting blood glucose,glycosylated hemoglobin and LDL-C,TG between the two groups.Chest pain was the most common symptom of angina pectoris in women and men,the proportion was 77.5%vs 76%,p=0.777.There was no significant difference in the proportion of chest tightness,palpitation,sweating,dyspnea,dizziness,abdominal pain and mandibular pain between male and male,but the proportion of nausea and vomiting(35.3%vs 20.2%,p=0.003)and back pain(30.3%vs 19.4%,p=0.016)in female were significantly higher than those in male.The average visit time in the female group was 2 hours later than that in the male group,which was 8(2.5,24)vs 6(2,21)hours,p=0.524.There was no significant difference in the ratio of female to male in emergency CAG(86.3%vs 92.1%),the degree of coronary artery disease(single vessel lesion:23%vs 17.5%,double vessel lesion:26.4%vs 26.5%,three vessel disease:44.8%vs 45.0%,complicated with left main lesion:5.7%vs 6.7%),criminal blood vessel,stent utilization rate,postoperative TIMI blood flow grade,IABP implantation ratio(3.4%vs 3.1%)and thrombus aspiration(8.0%vs 3.1%)between the two groups(p>0.05).There was no significant difference in the use of anti-coagulation(96.1%vs 95.9%)and the double antiplatelet therapy(aspirin:98.0%vs 95.5%,clopidogrel/ticagrelor:96.1%vs 96.3%)and secondary prevention(statin:95.1%vs 91.3%,ACEI/ARB:40.2%vs 50.8%,? receptor blockers:65.7%vs70.7%)between male and female,P>0.05?The number of days of hospitalization for the female group(7(6,10)vs7(6,8)days,p=0.024),cardiac function III-IV(18.6%vs 9.5%,p=0.024),BNP peak level(952(484.3,1546.5)vs.342.8(214.36,757.03)pg/ml,p<0.001)was higher than that of men.The incidence of acute renal failure(7.8%vs 1.7%,p=0.004),recurrent myocardial infarction(4.9%vs 0.4%,p=0.01),stent thrombosis(3.0%vs 0.0%,p=0.026),cardiac arrest(7.8%vs 0.4%,p<0.001)was also higher in the female group than in the male group.There was no statistical difference between the two groups of cardiogenic shock(7.8%vs 8.3%),gastrointestinal bleeding(3.0%vs 1.7%),and mechanical complications(2.0%vs 1.2%),p>0.05.The all-cause mortality rate in the female group was about twice as high as that in the male group,9.8%vs.4.5%,but there was no statistical significance between them,p>0.05.Conclusion:Female patients with STEMI have older onset age,more complications,more atypical symptoms,poor cardiac function,longer hospitalization time and higher incidence of adverse events during hospitalization.