Wilhelminenhospital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Vienna, Austria.
Wilhelminenhospital, 3rd Medical Department, Cardiology and Intensive Care Medicine, Vienna, Austria; Sigmund Freud Private University, Medical School, Vienna, Austria.
Int J Cardiol. 2017 Oct 1;244:303-308. doi: 10.1016/j.ijcard.2017.05.068.
Data obtained from registries have shown that women diagnosed with STEMI are older, have more co-morbidities and a worse clinical outcome than men. Aim of this study was to investigate potential gender differences in in-hospital and long-term mortality in patients from Vienna STEMI registry (2003-2009).
Data from 4593 patients who were enrolled from January 2003 until December 2009 into the Vienna STEMI registry were analyzed. Gender-related differences in patient characteristics, time delays, reperfusion therapy, as well as short- and long-term all-cause mortality were investigated. A landmark analysis was performed to assess long-term all-cause mortality in patients after discharge. Multivariate regression analysis was performed in order to correct for confounders.
Mean age, history of hypertension, diabetes mellitus and shock at presentation were significantly higher in women compared to men, whereas men were more frequently smokers, had more frequently a positive family history, a history of previous myocardial infarction and received more often GbIIb/IIIa inhibitors and reperfusion therapy. Overall the only significant difference in time delays was found in the onset of pain-to first medical contact time, which was significantly prolonged in women. Unadjusted in-hospital mortality, long-term mortality and long-term mortality for in-hospital survivors were statistically higher for women. After adjustment for confounders, multivariate analysis revealed no differences in mortalities between males and females.
The higher risk profile and the prolonged delay between onset of pain-to-first medical contact are responsible for the higher unadjusted mortality rates in women. Difference in short and long-term mortalities is no more existent after statistical correction for confounders such as age, co-morbidities and significantly different time delay.
注册数据表明，与男性相比，女性 STEMI 患者年龄更大，合并症更多，临床预后更差。本研究旨在调查维也纳 STEMI 注册中心（2003-2009 年）患者住院期间和长期死亡率的潜在性别差异。
分析了 2003 年 1 月至 2009 年 12 月期间纳入维也纳 STEMI 注册中心的 4593 名患者的数据。研究了患者特征、时间延迟、再灌注治疗以及短期和长期全因死亡率的性别差异。进行了里程碑分析，以评估出院后患者的长期全因死亡率。进行了多变量回归分析以校正混杂因素。
与男性相比，女性的平均年龄、高血压、糖尿病和就诊时休克的病史明显更高，而男性吸烟更多，阳性家族史、既往心肌梗死史更常见，更常使用 GbIIb/IIIa 抑制剂和再灌注治疗。总体而言，仅在疼痛至首次医疗接触时间的起始时间上发现了明显的时间延迟差异，女性的这一时间明显延长。未经调整的住院死亡率、长期死亡率和住院幸存者的长期死亡率在女性中更高。调整混杂因素后，多变量分析显示男性和女性之间死亡率无差异。
较高的风险状况和疼痛至首次医疗接触之间的延长时间延迟是女性未经调整死亡率较高的原因。在对年龄、合并症和明显不同的时间延迟等混杂因素进行统计学校正后，短期和长期死亡率的差异不再存在。
