Division of Cardiology, Ospedale "Maggiore della Carità", Eastern Piedmont University, Novara, Italy.
Atherosclerosis. 2013 Sep;230(1):12-6. doi: 10.1016/j.atherosclerosis.2013.05.024. Epub 2013 Jun 27.
Several studies have found that among patients with ST-segment elevation myocardial infarction (STEMI) treated by thrombolysis, female sex is associated with a worse outcome. However, still controversial is the prognostic impact of gender in primary angioplasty, especially in the era of drug-eluting stents (DES). Therefore, the aim of this study was to investigate sex-related differences in clinical outcome in patients with STEMI treated with primary angioplasty with Bare-Metal Stent (BMS) or DES.
Our population is represented by 6298 STEMI patients undergoing primary angioplasty and stent implantation included in the DESERT database. Follow-up data were collected from 3 to 6 years after primary angioplasty.
Female gender was observed in 1466 (23.2%) out of 6298 STEMI patients. Women were older (65.3 ± 12.4 vs 59.3 ± 11.4 years, p < 0.001), with higher prevalence of diabetes (18.6% vs 14.5%, p < 0.001), hypertension (52.4% vs 41.4%, p < 0.001), slightly longer ischemia time (272 ± 247 vs 258 ± 220 min, p = 0.06). No difference was observed in terms of angiographic and procedural characteristics. Follow-up data were available at a mean of 1201 ± 441 days. At long-term follow-up female gender was associated with a significantly higher rate of death (11.7% vs 8.5%, HR [95% CI] = 1.45 [1.18-1.78], p < 0.001), while no difference was observed in terms of reinfarction (HR [95% CI] = 1.14 [0.89-1.45], p = 0.3), ST (HR [95% CI] = 1.12 [0.85-1.48], p = 0.4), with similar temporal distribution (acute, subacute, late and very late) between male and female patients, and no difference in TVR (HR [95% CI] = 1.11 [0.95-1.3], p = 0.2, p = 0.2). These results were confirmed in both patients receiving BMS or DES. The impact of female gender on mortality disappeared after correction for baseline confounding factors (HR [95% CI] = 0.88 [0.71-1.09], p = 0.25).
This study shows that in patients with STEMI treated by primary angioplasty, female gender is associated with higher mortality rate in comparison with men, and this is mainly due to their higher clinical and angiographic risk profiles. In fact, female sex did not emerge as an independent predictor of mortality.
几项研究发现，在接受溶栓治疗的 ST 段抬高型心肌梗死（STEMI）患者中，女性性别与较差的预后相关。然而，在直接经皮冠状动脉介入治疗（PCI）时代，性别对预后的影响仍然存在争议，特别是在药物洗脱支架（DES）时代。因此，本研究旨在探讨接受直接 PCI 治疗的 STEMI 患者中，性别相关的临床结局差异，这些患者使用了 Bare-Metal Stent（BMS）或 DES。
我们的研究人群是包括在 DESERT 数据库中的 6298 例接受直接 PCI 和支架植入的 STEMI 患者。随访数据是在直接 PCI 后 3 至 6 年收集的。
在 6298 例 STEMI 患者中，有 1466 例（23.2%）为女性。女性年龄较大（65.3±12.4 岁 vs 59.3±11.4 岁，p<0.001），糖尿病（18.6% vs 14.5%，p<0.001）和高血压（52.4% vs 41.4%，p<0.001）的患病率更高，缺血时间稍长（272±247 分钟 vs 258±220 分钟，p=0.06）。在血管造影和手术特征方面没有差异。平均随访时间为 1201±441 天。在长期随访中，女性的死亡率明显更高（11.7% vs 8.5%，HR[95%CI] = 1.45[1.18-1.78]，p<0.001），而再梗死率无差异（HR[95%CI] = 1.14[0.89-1.45]，p=0.3），ST 段（HR[95%CI] = 1.12[0.85-1.48]，p=0.4），男女患者的时间分布相似（急性、亚急性、晚期和极晚期），且 TVR 无差异（HR[95%CI] = 1.11[0.95-1.3]，p=0.2，p=0.2）。在接受 BMS 或 DES 的患者中也得到了类似的结果。在调整基线混杂因素后，女性性别对死亡率的影响消失（HR[95%CI] = 0.88[0.71-1.09]，p=0.25）。
本研究表明，在接受直接 PCI 治疗的 STEMI 患者中，与男性相比，女性的死亡率更高，这主要归因于其更高的临床和血管造影风险特征。实际上，女性性别并不是死亡率的独立预测因素。
