Duke Clinical Research Institute, Durham, North Carolina, USA.
Am J Cardiol. 2012 Feb 1;109(3):320-6. doi: 10.1016/j.amjcard.2011.09.012. Epub 2011 Nov 10.
Gender-related differences in the incidence of bleeding and its relation to subsequent mortality in patients with ST-segment elevation myocardial infarction (STEMI) treated with fibrinolysis are not well understood. We studied patients with STEMI receiving fibrinolysis enrolled in 6 clinical trials. Outcomes included moderate or severe bleeding defined using Global Utilization of Strategies to Open Occluded Arteries (GUSTO) criteria and adjusted 1-year mortality (excluding deaths in first 24 hours). Moderate or severe bleeding was 1.9-fold higher in women compared to men (13.3% vs 7.1%, p <0.0001). Bleeding remained higher in women even after adjustment for baseline differences (odd ratios 1.52, 95% confidence interval [CI] 1.42 to 1.62). In fact, female gender was second most important prognostic factor (Wald chi-square 153.6) after older age (Wald chi-square 241.2) in the multivariable bleeding model. Overall 1-year mortality was similar in women and men after adjusting for prognostically important baseline differences (hazard ratio [HR] 1.06, 95% CI 0.97 to 1.17). However, after adjustment for baseline confounders and bleeding, female gender was associated with a lower risk of 1-year death. Thus, adjusted 1-year mortality was similar in women compared to men without bleeding (HR 1.08, 95% CI 0.97 to 1.19) but lower in women compared to men with bleeding (HR 0.85, 95% CI 0.73 to 0.98, p for interaction of gender by bleeding = 0.0016). The highest adjusted 1-year mortality was observed in men with bleeding (HR 2.42, 95% CI 2.20 to 2.66) followed by women with bleeding (HR 2.05, 95% CI 1.80 to 2.33) and women without bleeding (HR 1.08, 95% CI 0.97 to 1.19, referent men without bleeding). In conclusion, in patients with fibrinolytic-treated STEMI, women had a higher incidence but lower mortality with bleeding than men. These data highlight the importance of understanding factors associated with gender-related differences in bleeding and represent an opportunity for improving outcomes of women and men with fibrinolytic-treated STEMI.
在接受纤溶治疗的 ST 段抬高型心肌梗死（STEMI）患者中，性别与出血发生率及其与随后死亡率的关系尚不清楚。我们研究了接受纤溶治疗的 6 项临床试验中的 STEMI 患者。结局包括根据全球溶栓治疗临床试验组织（Global Utilization of Strategies to Open Occluded Arteries，GUSTO）标准定义的中度或重度出血和调整后的 1 年死亡率（排除前 24 小时内的死亡）。女性的中度或重度出血发生率是男性的 1.9 倍（13.3% vs 7.1%，p<0.0001）。即使在调整了基线差异后，女性的出血发生率仍然较高（比值比 1.52，95%置信区间[CI] 1.42 至 1.62）。实际上，在多变量出血模型中，女性性别是仅次于年龄（Wald chi-square 241.2）的第二大重要预后因素（Wald chi-square 153.6）。在调整了重要的预后基线差异后，女性和男性的 1 年死亡率相似（调整后的风险比[HR] 1.06，95%CI 0.97 至 1.17）。然而，在校正了基线混杂因素和出血后，女性性别与较低的 1 年死亡风险相关。因此，无出血的女性与男性相比，1 年死亡率相似（HR 1.08，95%CI 0.97 至 1.19），而有出血的女性与男性相比，1 年死亡率较低（HR 0.85，95%CI 0.73 至 0.98，p 为性别与出血之间的交互作用=0.0016）。出血男性的 1 年死亡率最高（HR 2.42，95%CI 2.20 至 2.66），其次是出血女性（HR 2.05，95%CI 1.80 至 2.33）和无出血女性（HR 1.08，95%CI 0.97 至 1.19，参考无出血男性）。总之，在接受纤溶治疗的 STEMI 患者中，女性的出血发生率较高，但出血后死亡率低于男性。这些数据强调了了解与性别相关的出血差异相关因素的重要性，并为改善接受纤溶治疗的 STEMI 患者的女性和男性结局提供了机会。
