Cohen Marc, Gensini Gian Franco, Maritz Frans, Gurfinkel Enrique P, Huber Kurt, Timerman Ari, Santopinto Jose, Corsini Giancarlo, Terrosu Pierfranco, Joulain Florence
Cardiac Catheterization Laboratory, Newark Beth Israel Medical Center, 201 Lyons Avenue, Newark, New Jersey, 07112, USA.
J Thromb Thrombolysis. 2005 Jun;19(3):155-61. doi: 10.1007/s11239-005-1524-1.
The standard of care for ST-segment elevation myocardial infarction (STEMI) is prompt coronary reperfusion with thrombolysis or percutaneous coronary intervention. Women have higher mortality rates than men following STEMI and fewer women are considered eligible for reperfusion therapy. We analyzed the impact of gender, and other factors, on the outcome and treatment of STEMI in the TETAMI trial and registry.
This exploratory analysis included 2741 patients from Treatment with Enoxaparin and Tirofiban in Acute Myocardial Infarction (TETAMI) presenting with STEMI within 24 hours of symptom onset. The primary composite end point was the combined incidence of all-cause death, recurrent myocardial infarction, and recurrent angina, at 30 days. Three multivariate analyses were performed to determine predictors of not receiving reperfusion therapy, the composite end point, or death.
The triple end point occurred in 17.8% of women versus 13.3% of men. Reperfusion therapy was utilized in 38.2% of women versus 47.3% in men. However, age > 75 years, delayed presentation, high systolic blood pressure (> 100) and region (South Africa), were significant, independent predictors of not receiving reperfusion therapy. Significant predictors of the triple end point included not receiving reperfusion therapy, age > 60 years, and higher Killip class. Predictors of death included age > 60 years, low systolic blood pressure, higher Killip class, high heart rate, delayed presentation, and region (South Africa and South America).
Female gender was not an independent predictor of outcome or underutilization of reperfusion therapy. Factors more common in female STEMI patients (advanced age and delayed presentation) were associated with not receiving reperfusion therapy and adverse outcome. Increased awareness is needed to reduce delayed presentation after symptom onset, especially among women. Abbreviated abstract. In this analysis of 2741 ST-segment elevation myocardial infarction patients in the TETAMI trial and registry, a trend was observed for women being less likely to receive reperfusion therapy and more likely to have an adverse outcome than men. This was related to factors more common in female patients (advanced age and delayed presentation), and showed that an increased awareness is needed to reduce delayed presentation after symptom onset, especially among women.
ST段抬高型心肌梗死（STEMI）的标准治疗是通过溶栓或经皮冠状动脉介入治疗迅速实现冠状动脉再灌注。STEMI后女性的死亡率高于男性，且被认为适合再灌注治疗的女性较少。我们在TETAMI试验和注册研究中分析了性别及其他因素对STEMI结局和治疗的影响。
这项探索性分析纳入了2741例急性心肌梗死依诺肝素和替罗非班治疗（TETAMI）研究中症状发作24小时内出现STEMI的患者。主要复合终点是30天时全因死亡、再发心肌梗死和再发心绞痛的联合发生率。进行了三项多变量分析以确定未接受再灌注治疗、复合终点或死亡的预测因素。
三联终点在17.8%的女性中出现，而在男性中为13.3%。38.2%的女性接受了再灌注治疗，男性为47.3%。然而，年龄>75岁、就诊延迟、收缩压高（>100）以及地区（南非）是未接受再灌注治疗的显著独立预测因素。三联终点的显著预测因素包括未接受再灌注治疗、年龄>60岁以及Killip分级较高。死亡的预测因素包括年龄>60岁、收缩压低、Killip分级较高、心率快、就诊延迟以及地区（南非和南美）。
女性性别并非结局或再灌注治疗未充分利用的独立预测因素。女性STEMI患者中更常见的因素（高龄和就诊延迟）与未接受再灌注治疗及不良结局相关。需要提高认识以减少症状发作后的就诊延迟，尤其是在女性中。简短摘要。在对TETAMI试验和注册研究中的2741例ST段抬高型心肌梗死患者的分析中，观察到一种趋势，即女性比男性接受再灌注治疗的可能性更小，出现不良结局的可能性更大。这与女性患者中更常见的因素（高龄和就诊延迟）有关，并表明需要提高认识以减少症状发作后的就诊延迟，尤其是在女性中。
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