Kytö Ville, Sipilä Jussi, Rautava Päivi
Heart Center, Turku University Hospital, Turku, Finland; PET Center, Turku University Hospital and University of Turku, Turku, Finland; Department of Medicine, University of Turku, Turku, Finland.
Division of Clinical Neurosciences, Neurology, Turku University Hospital, Turku, Finland; Department of Neurology, University of Turku, Turku, Finland.
Am J Cardiol. 2015 Feb 1;115(3):303-6. doi: 10.1016/j.amjcard.2014.11.001. Epub 2014 Nov 13.
Previous studies have suggested that women may be at higher risk of death after ST-segment elevation myocardial infarction (STEMI). We studied potential associations of gender and age with in-hospital mortality using a registry of 31,689 consecutive patients with STEMI aged ≥30 years (66.3% men, mean age 67.8 years) treated in 22 hospitals. Total in-hospital mortality rate of STEMI was 11.2%. Women had higher unadjusted mortality rate compared with men (17.5% vs 8.0%; hazard ratio 1.65; 95% confidence interval [CI] 1.54 to 1.76, p <0.0001). However, when adjusted for age and co-morbidities, there was no difference in mortality between genders overall (hazard ratio 1.04; 95% CI 0.97 to 1.12, p = 0.2303) or at any age group. Mortality rate was highly dependent of age with an estimated increase of 86% (95% CI 80% to 92%) per 10-year increase in age (p <0.0001). Chronic coronary, peripheral, or cerebral artery disease, diabetes, renal insufficiency, malignancy, and severe infection were independent predictors of mortality in multivariate analysis. Atrial fibrillation was associated with survival in multivariate model. Anterior location of STEMI was not independently associated with in-hospital mortality. In conclusion, although women have higher total in-hospital mortality rate than men after STEMI, this difference does not appear to be caused by gender itself but to be due to of differences in age and co-morbidities.
既往研究提示，女性在ST段抬高型心肌梗死（STEMI）后死亡风险可能更高。我们使用一个登记系统，对22家医院收治的31689例年龄≥30岁的连续性STEMI患者（男性占66.3%，平均年龄67.8岁）进行研究，以探讨性别和年龄与住院死亡率之间的潜在关联。STEMI患者的总体住院死亡率为11.2%。女性未经调整的死亡率高于男性（17.5%对8.0%；风险比1.65；95%置信区间[CI]为1.54至1.76，p<0.0001）。然而，在对年龄和合并症进行调整后，总体上两性之间的死亡率没有差异（风险比1.04；95%CI为0.97至1.12，p = 0.2303），在任何年龄组中均如此。死亡率高度依赖于年龄，估计每增加10岁，死亡率增加86%（95%CI为80%至92%）（p<0.0001）。在多变量分析中，慢性冠状动脉、外周或脑动脉疾病、糖尿病、肾功能不全、恶性肿瘤和严重感染是死亡率的独立预测因素。在多变量模型中，心房颤动与生存相关。STEMI的前壁部位与住院死亡率无独立关联。总之，虽然STEMI后女性的总体住院死亡率高于男性，但这种差异似乎不是由性别本身引起的，而是由于年龄和合并症的差异。
