Carrabba Nazario, Santoro Giovanni M, Balzi Daniela, Barchielli Alessandro, Marchionni Niccolò, Fabiani Plinio, Landini Cristina, Scarti Luca, Santoro Gennaro, Valente Serafina, Verdiani Valerio, Buiatti Eva
Cardiology Unit 1, Azienda Ospedaliera Careggi, Florence, Italy.
Am J Cardiol. 2004 Nov 1;94(9):1118-23. doi: 10.1016/j.amjcard.2004.07.076.
Primary percutaneous coronary intervention proved to be superior to thrombolysis in reducing ST-segment elevation acute myocardial infarction (STEAMI) mortality. However, whether such benefit is similar in women and men remains unclear. The aim of the present analysis was to assess the independent effect of female gender on management and on early and 1-year mortality in Florence, Italy, where primary percutaneous coronary intervention is the preferred reperfusion strategy for STEAMI. The study included a cohort of 920 unselected patients with STEAMI (men = 627, women = 293) prospectively enrolled in the AMI-Florence, population-based registry over 12 months. Women were older (76 vs 68 years, p <0.001) and more frequently had Killip class >I heart failure than men. The median delay to hospital admission was marginally longer in women (160 vs 130 minutes, p = 0.09). Coronary reperfusion treatment was performed less often in women (49% vs 58%, p <0.013); primary percutaneous coronary intervention was performed more often in both genders (90% vs 91%) and with similar median door-to-balloon time (50 vs 45 minutes, p = 0.44). Both in-hospital (16% vs 8%, p <0.001) and 1-year mortality (25% vs 18%, p = 0.016) were higher in women. However, after adjusting for age and other baseline characteristics, reperfusion treatment (odds ratio 1.27, 95% confidence interval [CI] 0.78 to 2.08) and 1-year mortality (hazard ratio [HR] 0.91, 95% CI 0.67 to 1.24) were independent of female gender. Compared with conservative therapy, reperfusion treatment was associated with a similar reduction in 1-year mortality in women (HR 0.59, 95% CI 0.34 to 1.02) and men (HR 0.58, 95% CI 0.37 to 0.92). Our data suggest that older age and several age-related factors may largely account for the higher mortality of women after STEAMI. Even in the general population,improvement in prognosis associated with reperfusion treatment is independent of gender.
在降低ST段抬高型急性心肌梗死（STEAMI）死亡率方面，直接经皮冠状动脉介入治疗被证明优于溶栓治疗。然而，这种益处在女性和男性中是否相似仍不清楚。本分析的目的是评估在意大利佛罗伦萨，女性性别对STEAMI治疗及早期和1年死亡率的独立影响，在该地直接经皮冠状动脉介入治疗是STEAMI首选的再灌注策略。该研究纳入了920例未经选择的STEAMI患者队列（男性627例，女性293例），这些患者在12个月内前瞻性纳入了基于人群的AMI - 佛罗伦萨登记处。女性年龄更大（76岁对68岁，p<0.001），且与男性相比，更频繁地出现Killip分级>I级心力衰竭。女性入院的中位延迟时间略长（160分钟对130分钟，p = 0.09）。女性接受冠状动脉再灌注治疗的频率较低（49%对58%，p<0.013）；两性中接受直接经皮冠状动脉介入治疗的频率更高（90%对91%），且门球时间中位数相似（50分钟对45分钟，p = 0.44）。女性的院内死亡率（16%对8%，p<0.001）和1年死亡率（25%对18%，p = 0.016）均更高。然而，在调整年龄和其他基线特征后，再灌注治疗（比值比1.27，95%置信区间[CI]0.78至2.08）和1年死亡率（风险比[HR]0.91，95%CI0.67至1.24）与女性性别无关。与保守治疗相比，再灌注治疗在女性（HR0.59，95%CI0.34至1.02）和男性（HR0.58，95%CI0.37至0.92）中与1年死亡率的降低相似。我们的数据表明，年龄较大和一些与年龄相关的因素可能在很大程度上解释了STEAMI后女性较高的死亡率。即使在一般人群中，与再灌注治疗相关的预后改善也与性别无关。
