Sarek Julita, Paczkowska Anita, Wilczyński Bartosz, Francuz Paweł, Podolecki Tomasz, Lenarczyk Radosław, Średniawa Beata, Kalarus Zbigniew, Kowalczyk Jacek
Department of Cardiology, Congenital Heart Diseases and Electrotherapy, Medical University of Silesia in Katowice, Silesian Center for Heart Diseases, Zabrze, Poland.
Postepy Kardiol Interwencyjnej. 2017;13(2):107-116. doi: 10.5114/pwki.2017.68048. Epub 2017 May 30.
Treating acute myocardial infarction (AMI) with percutaneous coronary intervention (PCI) has an impact on improving long-term outcome. However, patients with other comorbidities are challenging, and are considered as a high-risk population.
To assess gender-related differences in long-term prognosis after AMI among high-risk patients.
The single-center registry encompassed 4375 AMI patients treated with PCI. The following high-risk groups were selected: age > 70 group ( = 1081), glomerular filtration rate (GFR ) < 60 group ( = 848), diabetes mellitus (DM) group ( = 782), low ejection fraction (EF) group ( = 560) defined as EF < 35%, and incomplete coronary revascularization (ICR) group ( = 2008). Within each group, comparative analysis of long-term mortality with respect to gender and age was performed.
There were no significant differences in long-term mortality with respect to gender among groups with age > 70 (29.0% vs. 30.3%) and GFR < 60 (37.2% vs. 42.3%) (both = NS respectively for men vs. women). In the DM group (24.8% vs. 30.8%; = 0.06) and EF < 35% group (36.3% vs. 44.5%; = 0.07) there was a trend towards significance. The ICR group showed a higher mortality rate with respect to gender (19.7% vs. 27.3%; < 0.001). Differences in survival assessed by the log-rank test were significant among ICR and EF < 35% groups.
Female gender is related to higher long-term mortality among high-risk groups, but a statistically significant difference was observed only in patients with ICR and those with EF < 35%. Female gender may be associated with worse prognosis in diabetic patients, but it needs evaluation. However, worse prognosis in women was not independent and was associated mainly with other comorbidities and worse clinical characteristics.
经皮冠状动脉介入治疗（PCI）急性心肌梗死（AMI）对改善长期预后有影响。然而，患有其他合并症的患者具有挑战性，被视为高危人群。
评估高危患者急性心肌梗死后长期预后的性别差异。
单中心登记纳入了4375例行PCI治疗的AMI患者。选择以下高危组：年龄>70岁组（n = 1081）、肾小球滤过率（GFR）<60组（n = 848）、糖尿病（DM）组（n = 782）、低射血分数（EF）组（n = 560，定义为EF<35%）和不完全冠状动脉血运重建（ICR）组（n = 2008）。在每组中，对性别和年龄的长期死亡率进行比较分析。
年龄>70岁组（29.0%对30.3%）和GFR<60组（37.2%对42.3%）中，性别间长期死亡率无显著差异（男性对女性，P值均无统计学意义）。DM组（24.8%对30.8%；P = 0.06）和EF<35%组（36.3%对44.5%；P = 0.07）有显著趋势。ICR组显示出性别间较高的死亡率（19.7%对27.3%；P<0.001）。通过对数秩检验评估的生存差异在ICR组和EF<35%组中具有统计学意义。
女性在高危组中与较高的长期死亡率相关，但仅在ICR患者和EF<35%的患者中观察到统计学显著差异。女性性别可能与糖尿病患者预后较差有关，但需要评估。然而，女性预后较差并非独立因素，主要与其他合并症和较差的临床特征有关。
