2005年至2011年波兰ST段抬高型心肌梗死患者临床特征、治疗策略及死亡率的性别差异趋势
Trends in sex differences in clinical characteristics, treatment strategies, and mortality in patients with ST-elevation myocardial infarction in Poland from 2005 to 2011.
作者信息
Zandecki Lukasz, Sadowski Marcin, Janion Marianna, Gierlotka Marek, Gasior Mariusz, Polonski Lech
机构信息
a2nd Cardiology Clinic bDepartment of Interventional Cardiology, Swietokrzyskie Cardiology Center cInstitute of Medical Sciences dInstitute of Nursing and Obstetrics, The Faculty of Medicine and Health Sciences, The Jan Kochanowski University, Kielce e3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Silesian Centre for Heart Diseases, Medical University of Silesia in Katowice, Zabrze, Poland.
出版信息
Coron Artery Dis. 2017 Aug;28(5):417-425. doi: 10.1097/MCA.0000000000000504.
INTRODUCTION
During the last decade, there has been an increased awareness of sex differences in the clinical characteristics, management, and mortality in myocardial infarction. Many previous studies have found that women with ST-elevation myocardial infarction (STEMI) have a poorer baseline risk profile, are less intensively treated, and have worse outcomes.
OBJECTIVE
To evaluate whether sex disparities in STEMI have changed in recent years.
METHODS
This is a retrospective analysis of data on 111 148 STEMI patients enrolled in the Polish Registry of Acute Coronary Syndromes between 2005 and 2011. Temporal trends in the clinical presentation, treatment strategies, and mortality rates between men and women are compared.
RESULTS
Throughout the study, women were, on average, older than men, and more frequently presented with hypertension, diabetes, or obesity. These differences showed a tendency for narrowing. The percentage of smokers increased in both sexes. Despite a reduction in prehospital delays, they remained longer in women. Sex differences in prehospital cardiac arrest and cardiogenic shock at admission disappeared. In 2011, women were still less likely to undergo coronary angiography with subsequent revascularization, but it was mainly driven by patients older than 70 years of age who also had a higher in-hospital mortality. Despite the greater relative risk reductions, the crude mortality rates remained significantly higher in women. Female sex was not an independent predictor of mortality.
CONCLUSION
Sex differences in STEMI patients were narrowing from 2005 to 2011 in Poland. However, more attention needs to be focused on increasing smoking prevalence, the longer times from symptoms onset to hospital admission in women and the lower frequencies of the use of an invasive treatment strategy in older women, and their worse in-hospital outcomes.
引言
在过去十年中，人们越来越意识到心肌梗死在临床特征、治疗和死亡率方面存在性别差异。许多先前的研究发现，患有ST段抬高型心肌梗死（STEMI）的女性基线风险状况较差，接受的治疗强度较低，且预后较差。
目的
评估近年来STEMI患者中的性别差异是否发生了变化。
方法
这是一项对2005年至2011年纳入波兰急性冠状动脉综合征登记处的111148例STEMI患者数据的回顾性分析。比较了男性和女性在临床表现、治疗策略和死亡率方面的时间趋势。
结果
在整个研究过程中，女性平均年龄比男性大，更频繁地出现高血压、糖尿病或肥胖。这些差异呈现出缩小的趋势。男女吸烟者的比例均有所增加。尽管院前延误有所减少，但女性的延误时间仍然更长。入院时院前心脏骤停和心源性休克的性别差异消失。2011年，女性接受冠状动脉造影及随后血运重建的可能性仍然较低，但这主要是由70岁以上的患者驱动的，这些患者院内死亡率也较高。尽管相对风险降低幅度更大，但女性的粗死亡率仍然显著更高。女性性别不是死亡率的独立预测因素。
结论
2005年至2011年期间，波兰STEMI患者中的性别差异正在缩小。然而，需要更多关注吸烟率上升、女性从症状发作到入院时间更长、老年女性侵入性治疗策略使用频率较低以及她们较差的院内结局等问题。
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