Humanitas Clinical and Research Center, Department of Interventional Cardiology, Rozzano, Milan, Italy.
Humanitas Clinical and Research Center, Department of Interventional Cardiology, Rozzano, Milan, Italy.
Am J Cardiol. 2014 Aug 1;114(3):336-41. doi: 10.1016/j.amjcard.2014.05.007. Epub 2014 May 15.
The aim of this study was to assess recent trends in hospital mortality and in the treatment techniques for patients with ST-segment elevation myocardial infarction according to gender. Data on hospitalizations for ST-segment elevation myocardial infarction from 2000 to 2010 were extracted from hospital discharge record databases (International Classification of Diseases, Ninth Revision, Clinical Modification, codes) in the Lombardy Region of Italy. The impact of female gender on in-hospital mortality was assessed by multivariable regression after adjusting for invasive approach use (i.e., coronary angiography, angioplasty or coronary artery bypass graft), age, and co-morbidities. A total of 89,562 patients, men (66.5%) and women (33.5%), were enrolled. The use of an invasive approach increased over time in both sexes although it was higher in men (from 54.9% in 2000 to 91.9% in 2010 in men; from 36.8% in 2000 to 72.0% in 2010 in women). This pattern was driven by the subgroup of patients aged ≥75 years, whereas differences between sexes were not observed in patients <65 years and were small in patients aged 65 to 74 years. In-hospital mortality presented a small decrease from 7.6% in 2000 to 6.2% in 2010 in men (p for trend = 0.004), whereas it remained higher and substantially constant over time in women (16.6% in 2000, 15.5% in 2010, p for trend = 0.09). At multivariable regression, female gender did not emerge as an independent predictor of mortality (p = 0.13). However, a significant gender-age interaction was found, with female gender being a significant predictor of increased mortality in patients aged ≥75 years (odds ratio [OR] 1.33) while predicting a reduced mortality in patients aged <75 years (OR 0.93, p for interaction <0.0001). The use of an invasive approach was an independent predictor of mortality (OR 0.23, p <0.0001), the magnitude of mortality reduction being higher in men than in women and in patients aged <75 years than in those aged ≥75 years. In conclusion, a weak temporal trend in mortality reduction is observed in men only, which is driven by patients aged ≥75 years. In-hospital mortality remains higher in women than in men, although female gender is not a significant predictor of mortality. Despite temporal increases in the use of an invasive approach, women are more often treated conservatively.
本研究旨在评估根据性别，ST 段抬高型心肌梗死（STEMI）患者的住院死亡率和治疗技术的近期趋势。从意大利伦巴第地区的住院记录数据库（国际疾病分类，第 9 版，临床修正版，代码）中提取了 2000 年至 2010 年 STEMI 住院数据。通过多变量回归，在校正介入治疗（即冠状动脉造影、血管成形术或冠状动脉旁路移植术）使用率、年龄和合并症后，评估女性性别对住院死亡率的影响。共纳入 89562 名患者，男（66.5%）女（33.5%）。两种性别均呈现出介入治疗使用率随时间增加的趋势，然而男性的使用率更高（2000 年为 54.9%，2010 年为 91.9%；2000 年为 36.8%，2010 年为 72.0%）。这种模式是由≥75 岁的患者亚组驱动的，而在<65 岁的患者中，性别间差异不明显，在 65-74 岁的患者中差异较小。男性的住院死亡率从 2000 年的 7.6%下降至 2010 年的 6.2%（趋势检验 p = 0.004），而女性的死亡率一直较高且保持不变。多变量回归显示，女性性别并非死亡率的独立预测因素（p = 0.13）。然而，发现了一个显著的性别-年龄交互作用，即女性性别是≥75 岁患者死亡风险增加的一个显著预测因素（比值比[OR] 1.33），而在<75 岁患者中则是死亡风险降低的一个显著预测因素（OR 0.93，p 交互作用 <0.0001）。介入治疗的使用是死亡率的一个独立预测因素（OR 0.23，p <0.0001），且男性的死亡率降低幅度大于女性，<75 岁患者的死亡率降低幅度大于≥75 岁患者。总之，仅在≥75 岁的患者中观察到死亡率降低的微弱趋势，而这种趋势是由≥75 岁的患者驱动的。尽管介入治疗的使用随着时间的推移而增加，但女性的死亡率仍高于男性，尽管女性性别并不是死亡率的一个显著预测因素。尽管介入治疗的使用随着时间的推移而增加，但女性更常采用保守治疗。
