Department of Internal Medicine and Cardiovascular Center, Seoul National University Bundang Hospital, Gyeonggido, Korea.
Am J Cardiol. 2012 Mar 15;109(6):787-93. doi: 10.1016/j.amjcard.2011.11.006. Epub 2011 Dec 22.
There has been controversy over the disparity between men and women with regard to the management and prognosis of acute myocardial infarction. Analyzing nationwide multicenter prospective registries in Korea, the aim of this study was to determine whether female gender independently imposes a risk for mortality. Data from 14,253 patients who were hospitalized for ST-segment elevation myocardial infarction from November 2005 to September 2010 were extracted from registries. Compared to men, women were older (mean age 56 ± 12 vs 67 ± 10 years, p < 0.001), and female gender was associated with a higher frequency of co-morbidities, including hypertension, diabetes, and dyslipidemia. Women had longer pain-to-door time and more severe hemodynamic status than men. All-cause mortality rates were 13.6% in women and 7.0% in men at 1 year after the index admission (hazard ratio for women 2.01, 95% confidence interval 1.80 to 2.25, p < 0.001). The risk for death after ST-segment elevation myocardial infarction corresponded highly with age. Although the risk remained high after adjusting for age, further analyses adjusting for medical history, clinical performance, and hemodynamic status diminished the gender effect (hazard ratio 1.00, 95% confidence interval 0.86 to 1.17, p = 0.821). Propensity score matching, as a sensitivity analysis, corroborated the results. In conclusion, this study shows that women have a comparable risk for death after ST-segment elevation myocardial infarction as men. The gender effect was accounted for mostly by the women's older age, complex co-morbidities, and severe hemodynamic conditions at presentation.
关于急性心肌梗死的治疗和预后，男性和女性之间存在争议。本研究旨在通过分析韩国全国多中心前瞻性注册研究，确定女性性别是否独立增加死亡率。从 2005 年 11 月至 2010 年 9 月登记的因 ST 段抬高型心肌梗死住院的 14253 例患者中提取数据。与男性相比，女性年龄更大（平均年龄 56 ± 12 岁 vs 67 ± 10 岁，p < 0.001），并且女性合并症的发生率更高，包括高血压、糖尿病和血脂异常。女性的疼痛至门时间更长，血流动力学状态比男性更严重。在指数入院后 1 年，女性的全因死亡率为 13.6%，男性为 7.0%（女性的风险比为 2.01，95%置信区间为 1.80 至 2.25，p < 0.001）。ST 段抬高型心肌梗死患者的死亡风险与年龄高度相关。尽管在调整年龄后风险仍然较高，但进一步分析调整病史、临床表现和血流动力学状态后，性别差异减弱（风险比为 1.00，95%置信区间为 0.86 至 1.17，p = 0.821）。敏感性分析中的倾向评分匹配也证实了这一结果。总之，本研究表明，女性在 ST 段抬高型心肌梗死后的死亡风险与男性相当。性别差异主要归因于女性年龄较大、合并症复杂以及入院时血流动力学状态严重。
