University of Zurich, Zurich, Switzerland.
Eur Heart J Acute Cardiovasc Care. 2012 Sep;1(3):183-91. doi: 10.1177/2048872612454021.
Few data are available concerning the impact of gender on temporal trends in patients with acute ST-segment elevation myocardial infarction (STEMI).
All STEMI patients consecutively enrolled in the AMIS (Acute Myocardial Infarction in Switzerland) Plus project from 1997-2011 were included. Temporal trends in presentation, treatment and outcomes were analyzed using multiple logistic regressions with generalized estimations.
Of 21,620 STEMI patients, 5786 were women and 15,834 men from 78 Swiss hospitals. Women were 8.6 years older, presented 48 minutes later with less pain, but more dyspnea, and more frequently had atrial fibrillation (5.5 vs. 3.9%, p<0.001), heart failure (Killip class >2) (9.7 vs. 7.3%, p<0.001), and moderate or severe comorbidities (24.8 vs. 18.2%, p<0.001). Women were less likely to undergo primary reperfusion treatment after adjustment for baseline characteristics and admission year (OR 0.80, 95% CI 0.71-0.90, p<0.001) or receive early and discharge drugs, such as thienopyridines, angiotensin-converting-enzyme inhibitors, angiotensin II receptor antagonists, and statins. In 1997, thrombolysis was performed in 51% of male and 39% of female patients; its use rapidly decreased during the 1990s and has now become negligible. Primary percutaneous coronary intervention increased from under 10% in both genders in 1997 to over 70% in females and over 80% in males since 2006. Patients admitted in cardiogenic shock increased by 8% per year in both genders. The incidence of both reinfarction and cardiogenic shock developing during hospitalization decreased significantly over 15 years while in-hospital mortality decreased from 10 to 5% in men and from 18 to 7% in women. This corresponds to a relative reduction of 5% per year for males (OR 0.95, 95% CI 0.92-0.99, p=0.006) and 6% per year for female STEMI patients (OR 0.94, 95% CI 0.91-0.97, p<0.001). Despite higher crude in-hospital mortality, female gender per se was not an independent predictor of in-hospital mortality (OR 1.07, 95% CI 0.84-1.35, p=0.59).
Substantial changes have occurred in presentation, treatment, and outcome of men and women with STEMI in Switzerland over the past 15 years. Although parallel trends were seen in both groups, ongoing disparities in certain treatments remain. However, these did not translate into worse risk-adjusted in-hospital mortality, suggesting that the gender gap in STEMI care may be closing.
关于性别对急性 ST 段抬高型心肌梗死（STEMI）患者时间趋势的影响，数据有限。
纳入了 1997 年至 2011 年期间瑞士 AMIS（瑞士急性心肌梗死）加项目中连续入组的所有 STEMI 患者。使用广义估计的多元逻辑回归分析了就诊、治疗和结局的时间趋势。
在 21620 例 STEMI 患者中，78 家瑞士医院的 5786 例为女性，15834 例为男性。女性患者年龄大 8.6 岁，就诊时疼痛程度较轻，但呼吸困难更严重，心房颤动（5.5% vs. 3.9%，p<0.001）、心力衰竭（Killip 分级>2）（9.7% vs. 7.3%，p<0.001）和中度或重度合并症（24.8% vs. 18.2%，p<0.001）更为常见。在调整基线特征和入院年份后，女性患者接受直接再灌注治疗的可能性较低（OR 0.80，95% CI 0.71-0.90，p<0.001）或接受早期和出院药物，如噻吩吡啶类、血管紧张素转换酶抑制剂、血管紧张素 II 受体拮抗剂和他汀类药物的可能性较低。1997 年，男性患者中有 51%接受了溶栓治疗，女性患者中有 39%接受了溶栓治疗；在 1990 年代，溶栓治疗的使用率迅速下降，现在已变得微不足道。自 2006 年以来，女性患者中直接经皮冠状动脉介入治疗的比例从 1997 年的不足 10%增加到 70%以上，男性患者中直接经皮冠状动脉介入治疗的比例从 80%以上增加到 80%以上。心源性休克入院患者每年增加 8%。15 年来，住院期间再梗死和心源性休克的发生率显著下降，而男性患者的住院死亡率从 10%降至 5%，女性患者的住院死亡率从 18%降至 7%。这相当于男性患者每年减少 5%（OR 0.95，95% CI 0.92-0.99，p=0.006）和女性患者每年减少 6%（OR 0.94，95% CI 0.91-0.97，p<0.001）。尽管住院死亡率较高，但女性性别本身并不是住院死亡率的独立预测因素（OR 1.07，95% CI 0.84-1.35，p=0.59）。
在过去的 15 年中，瑞士男性和女性 STEMI 患者的就诊、治疗和结局发生了重大变化。尽管两组都呈现出类似的趋势，但某些治疗方法的持续差异仍然存在。然而，这并没有转化为风险调整后住院死亡率的恶化，这表明 STEMI 护理中的性别差距可能正在缩小。
