Kanic Vojko, Vollrath Maja, Tapajner Alojz, Sinkovic Andreja
1 Department of Cardiology and Angiology, University Medical Centre Maribor , Maribor, Slovenia .
2 Herzzentrum Leipzig, Leipzig, Germany .
J Womens Health (Larchmt). 2017 Apr;26(4):374-379. doi: 10.1089/jwh.2016.5957. Epub 2017 Mar 29.
The data on sex as an independent risk factor for death in acute myocardial infarction (MI) patients are still contrasting. The aim was to assess how sex influences 30-day and long-term all-cause mortality in MI patients undergoing percutaneous coronary intervention (PCI).
Data from 3624 MI patients undergoing PCI at our institution from January 2009 to December 2014, 30.6% were women, were analyzed. A propensity-matched analysis was performed to adjust for differences in the baseline characteristics between men and women. The effect of sex on 30-day and long-term mortality was observed. Multivariate logistic regression modeling was used for 30-day mortality and Cox regression analysis for long-term mortality. The median follow-up time was 27 months (25th, 75th percentile: 9, 48).
Women had a significantly higher unadjusted 30-day (5.9% in men vs. 9.5% in women; p < 0.0001) and long-term mortality (13.5% in men vs. 19.0% in women; p < 0.0001). In a propensity-matched analysis, female sex was not associated with a higher 30-day (adjusted odds ratio: 1.46; 95% confidence interval: 0.97-2.19) or long-term mortality (hazard ratio 1.02; 95% CI 0.81-1.28). Age older than 77 years, cardiogenic shock, PCI of left anterior descending artery (LAD), thrombolysis in myocardial infarction (TIMI) flow less than 3 after PCI, hypertension, dyslipidemia, and P2Y12 receptor antagonists were identified as independent predictors of 30-day and long-term mortality. In addition, renal failure requiring dialysis predicted long-term mortality.
Older age, comorbidities, worse clinical presentation, and adjunctive pharmacotherapy rather than sex may explain the higher mortality rate in women with MI undergoing PCI.
关于性别作为急性心肌梗死（MI）患者死亡独立危险因素的数据仍存在争议。目的是评估性别如何影响接受经皮冠状动脉介入治疗（PCI）的MI患者的30天和长期全因死亡率。
分析了2009年1月至2014年12月在我院接受PCI的3624例MI患者的数据，其中30.6%为女性。进行倾向匹配分析以调整男性和女性基线特征的差异。观察性别对30天和长期死亡率的影响。采用多变量逻辑回归模型分析30天死亡率，采用Cox回归分析长期死亡率。中位随访时间为27个月（第25、75百分位数：9、48）。
女性未经调整的30天死亡率（男性为5.9%，女性为9.5%；p<0.0001）和长期死亡率（男性为13.5%，女性为19.0%；p<0.0001）显著更高。在倾向匹配分析中，女性性别与较高的30天死亡率（调整后的优势比：1.46；95%置信区间：0.97-2.19）或长期死亡率（风险比1.02；95%CI 0.81-1.28）无关。年龄大于77岁、心源性休克、左前降支动脉（LAD）PCI、PCI后心肌梗死溶栓（TIMI）血流小于3、高血压、血脂异常和P2Y12受体拮抗剂被确定为30天和长期死亡率的独立预测因素。此外，需要透析的肾衰竭可预测长期死亡率。
年龄较大、合并症、临床表现较差和辅助药物治疗而非性别可能解释了接受PCI的MI女性患者死亡率较高的原因。
