여성 급성 심근경색증 환자의 연령에 따른 임상 양상 및 장기 추적 경과 관찰.

Abstract

Background and Objectives：The purpose of this study was to evaluate the age-related differences in clinical features, coronary anatomy, risk factors, hospital courses, and long-term prognosis of acute myocardial infarction (AMI) in women. Materials and Methods：Total 513 female patients with AMI were divided into 3 groups； group 1 (n＝43, 50 years old or less), group 2 (n＝302, between 51 years and 70 years old), and group 3 (n＝ 168, older than 70 years). Clinical follow-up including cardiac events was performed for mean duration of 26 months (1-155 months). Cardiac events include cardiac death, reinfarction, CABG, PTCA, CHF, stroke, and recurrent angina. Results：Minimal lesion (<50% stenosis) in infarct-related artery was more prevalent in group 1 than in group 3 (p<0.05). In group 2, the number of low high density lipoprotein (HDL) was significantly more than in group 3 (p<0.01). During hospitalization, death and shock were more prevalently observed in group 3 than group 1 (p<0.005) and group 2 (p<0.001). Group 3 had more heart failures than group 1 (p<0. 001) and group 2 (p<0.001) and group 2 had more heart failures than group 1 (p<0.05). The younger age group showed a significantly higher survial rate (7 years：group 1；76.1%, group 2；60.6%, group 3；34.2%, p<0. 0001, Log Rank Stat＝49.4) and cardiac event-free survival rate (7 years：group 1； 48.4%, group 2； 32. 3%, group 3；16.0%, p<0.0001, Log Rank Stat＝37.5) for each 3 comparisons. In Cox proportional harzard analysis, LV systolic function influenced the group 2 survival (odds ratio 3.8, 95% CI 1.7 to 8.3, p<0.005) and the group 3 survival (odds ratio 2.2, 95% CI 1.1 to 4.5, p<0.05). The cardiac event free survival was influenced by age (odds ratio 1.6, 95% CI 1.2 to 2.1, p<0.005) and LV systolic function (odds ratio 1.8, 95% CI 1.3 to 2.5, p<0.001). Conclusion：Younger female patients with AMI had a more favorable prognosis compared with older female patients. LV systolic fuction was important as a prognostic factor for long-term survival except younger female AMI patients.