Cardiovascular Research Foundation, 1700 Broadway, 9th Floor, New York, NY 10019, USA.
Columbia University Medical Center, New York Presbyterian Hospital, New York, NY, USA.
Eur Heart J. 2017 Jun 1;38(21):1656-1663. doi: 10.1093/eurheartj/ehx159.
Studies have reported less favourable outcomes in women compared with men after primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI). Whether sex-specific differences in the magnitude or prognostic impact of infarct size or post-infarction cardiac function explain this finding is unknown.
We pooled patient-level data from 10 randomized primary PCI trials in which infarct size was measured within 1 month (median 4 days) by either cardiac magnetic resonance imaging or technetium-99m sestamibi single-photon emission computed tomography. We assessed the association between sex, infarct size, and left ventricular ejection fraction (LVEF) and the composite rate of death or heart failure (HF) hospitalization within 1 year. Of 2632 patients with STEMI undergoing primary PCI, 587 (22.3%) were women. Women were older than men and had a longer delay between symptom onset and reperfusion. Infarct size did not significantly differ between women and men, and women had higher LVEF. Nonetheless, women had a higher 1-year rate of death or HF hospitalization compared to men, and while infarct size was a strong independent predictor of 1-year death or HF hospitalization (P < 0.0001), no interaction was present between sex and infarct size or LVEF on the risk of death or HF hospitalization.
In this large-scale, individual patient-level pooled analysis of patients with STEMI undergoing primary PCI, women had a higher 1-year rate of death or HF hospitalization compared to men, a finding not explained by sex-specific differences in the magnitude or prognostic impact of infarct size or by differences in post-infarction cardiac function.
研究报告称，与男性相比，女性在 ST 段抬高型心肌梗死（STEMI）行初次经皮冠状动脉介入治疗（PCI）后结局较差。是否存在性别特异性差异，导致心肌梗死面积或梗死后心功能的严重程度或预后影响不同，尚不清楚。
我们汇总了 10 项随机初次 PCI 试验的患者水平数据，这些试验在 1 个月内（中位数为 4 天）通过心脏磁共振成像或锝-99m 替曲膦单光子发射计算机断层扫描来测量心肌梗死面积。我们评估了性别、心肌梗死面积和左心室射血分数（LVEF）与 1 年内死亡或心力衰竭（HF）住院的复合发生率之间的相关性。在 2632 例接受初次 PCI 的 STEMI 患者中，587 例（22.3%）为女性。女性比男性年龄更大，且从发病到再灌注的时间间隔更长。女性的心肌梗死面积与男性无显著差异，而 LVEF 更高。然而，女性 1 年的死亡或 HF 住院率高于男性，且尽管心肌梗死面积是 1 年死亡或 HF 住院的强烈独立预测因素（P<0.0001），但性别与心肌梗死面积或 LVEF 对死亡或 HF 住院风险无交互作用。
在这项对接受初次 PCI 的 STEMI 患者进行的大规模、个体化患者水平汇总分析中，与男性相比，女性 1 年的死亡或 HF 住院率更高，这种发现不能用心肌梗死面积的严重程度或预后影响或梗死后心功能的差异来解释。
