Isala Klinieken, Zwolle, The Netherlands.
Eur Heart J Acute Cardiovasc Care. 2013 Dec;2(4):334-41. doi: 10.1177/2048872612475270. Epub 2013 Jan 31.
Poorer outcomes in women with ST-elevation myocardial infarction (STEMI) are often attributed to gender differences in baseline characteristics. However, these may be age dependent. We examined the importance of gender in separate age groups of patients with STEMI undergoing primary percutaneous coronary intervention (PPCI).
Data of 6746 consecutive patients with STEMI admitted for PPCI between 1998 and 2008 in our hospital were evaluated. Age was stratified into two groups, <65 years (young group) and ≥65 years (elderly). Endpoints were enzymic infarct size as well as 30-day and 1 year mortality. We studied a total of 4991 (74.0%) men and 1755 (26.0%) women; 40% of women were <65 years and 60% of men were <65 years of age. In the elderly group (≥65 years), women had more frequently diabetes and hypertension while they smoked less frequently than men. Younger women smoked more often than similarly aged men and had more hypertension. At angiography, single-vessel disease and TIMI 3 flow before PPCI was more present in younger women than men, whereas these differences were not found in the older age group. Patient delay before admission was shorter in men at all ages, while women had lower creatine kinase levels. Younger women had a higher mortality after 30 days (HR 2.1, 95% CI 1.3-3.4) and at 1 year (HR 1.7, 95% CI 1.2-2.6), whereas in the older age group women mortality rates were higher at 30 days (HR 1.5, 95% CI 1.1-2.0) but not at 1 year (HR 1.2, 95% CI 0.9-1.5). After multivariate analysis, 1-year mortality remained significantly higher in women at younger age (HR 1.7, 95% CI 1.1-2.5). Patient delay before admission was shorter in men in both age groups. Creatine kinase levels were in both age groups higher in men.
Differences in mortality between men and women with STEMI treated with PPCI are age dependent. Although young women have less obstructive coronary artery disease and more often TIMI 3 flow before PCI (suggesting a lower risk), survival was worse compared to similarly aged men. Women had a longer patient delay compared to men, but this was not related to gender-specific mortality.
ST 段抬高型心肌梗死（STEMI）女性患者的预后较差，通常归因于基线特征的性别差异。然而，这些差异可能与年龄有关。我们在接受直接经皮冠状动脉介入治疗（PPCI）的 STEMI 患者的两个年龄组中，分别检查了性别在其中的重要性。
对我院 1998 年至 2008 年间收治的 6746 例 STEMI 患者的 PPCI 数据进行了评估。年龄分为两组，<65 岁（年轻组）和≥65 岁（老年组）。终点是酶学梗死面积以及 30 天和 1 年死亡率。我们共研究了 4991 名（74.0%）男性和 1755 名（26.0%）女性；40%的女性<65 岁，60%的男性<65 岁。在老年组（≥65 岁）中，女性糖尿病和高血压更为常见，而吸烟较少。年轻女性比同龄男性吸烟更频繁，且高血压更多。在血管造影时，年轻女性比男性更常出现单支血管病变和 PPCI 前 TIMI 3 级血流，而在年龄较大的组中则没有发现这种差异。在所有年龄段，男性的入院前患者延迟时间都较短，而女性的肌酸激酶水平较低。年轻女性 30 天后的死亡率更高（HR 2.1，95%CI 1.3-3.4），1 年后死亡率更高（HR 1.7，95%CI 1.2-2.6），而在年龄较大的组中，30 天后女性死亡率更高（HR 1.5，95%CI 1.1-2.0），但 1 年后则无差异（HR 1.2，95%CI 0.9-1.5）。多变量分析后，年轻女性的 1 年死亡率仍显著高于男性（HR 1.7，95%CI 1.1-2.5）。在两个年龄组中，男性的入院前患者延迟时间都较短。在两个年龄组中，男性的肌酸激酶水平都较高。
接受 PPCI 治疗的 STEMI 男性和女性的死亡率差异与年龄有关。尽管年轻女性的冠状动脉阻塞性疾病较少，且 PCI 前 TIMI 3 级血流更常见（表明风险较低），但与同龄男性相比，生存情况较差。与男性相比，女性的入院前患者延迟时间较长，但这与性别特异性死亡率无关。
