Jabbari Reza, Glinge Charlotte, Risgaard Bjarke, Lynge Thomas Hadberg, Winkel Bo Gregers, Haunsø Stig, Albert Christine M, Engstrøm Thomas, Tfelt-Hansen Jacob
Heart Centre, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, 9441, Blegdamsvej 9, 2100, Copenhagen Ø, Denmark.
Laboratory of Molecular Cardiology, Department of Cardiology, Copenhagen University Hospital, Rigshospitalet, Juliane Mariesvej 20, 2100, Copenhagen Ø, Denmark.
J Interv Card Electrophysiol. 2017 Oct;50(1):133-140. doi: 10.1007/s10840-017-0284-0. Epub 2017 Sep 22.
We aimed to assess sex differences in clinical characteristics, circumstances of arrest, and procedural characteristics in ST-elevation myocardial infarction (STEMI) patients with ventricular fibrillation (VF) prior to angioplasty.
Cases of VF with first STEMI (n = 329; 276 men and 53 women) were identified from the GEVAMI study, which is prospectively assembled case-control study among first STEMI patients in Denmark.
Compared to men, women experienced symptoms for a longer time interval prior to angioplasty (140 vs. 166 min, p = 0.020), and were more likely to present with VF later during transport to the hospital rather than prior to emergency medical services arrival (36 vs. 52%, p = 0.040). Prior to VF, women had a significantly lower income (p = 0.002) and education level (p = 0.008), were less likely to consume alcohol (3 vs. 6 units, p = 0.040), more likely to smoke (71 vs. 52%, p = 0.007), and more likely to have depression (25 vs. 10%, p = 0.002) or a history of angina (59 vs. 42%, p = 0.030). Even though women had more angina within a year prior to VF, no difference was observed in self-reported contact with the healthcare system (p = 0.200). In multivariable logistic regression models, history of angina (OR = 2.70; p = 0.006), low educational level (OR = 2.80, p = 0.012) and low income (OR = 6.00, p = 0.005) remained significantly associated with female sex. There were no differences in procedural characteristics between men and women.
We found several sex differences in clinical characteristics and circumstances of arrest. The importance of seeking acute medical attention when experiencing angina should be emphasized in women, especially in women with low socioeconomic status.
我们旨在评估接受血管成形术之前发生心室颤动（VF）的ST段抬高型心肌梗死（STEMI）患者在临床特征、发病情况及手术特征方面的性别差异。
从GEVAMI研究中识别出首次发生STEMI且伴有VF的病例（n = 329；男性276例，女性53例），该研究是丹麦针对首次发生STEMI患者进行的前瞻性病例对照研究。
与男性相比，女性在血管成形术之前出现症状的时间间隔更长（140分钟对166分钟，p = 0.020），且在转运至医院期间而非紧急医疗服务到达之前更有可能出现VF（36%对52%，p = 0.040）。在发生VF之前，女性的收入（p = 0.002）和教育水平（p = 0.008）显著较低，饮酒量较少（3单位对6单位，p = 0.040），吸烟可能性更大（71%对52%，p = 0.007），患抑郁症的可能性更大（25%对10%，p = 0.002）或有心绞痛病史的可能性更大（59%对42%，p = 0.030）。尽管女性在发生VF前一年内心绞痛发作更频繁，但在自我报告的与医疗系统接触方面未观察到差异（p = 0.200）。在多变量逻辑回归模型中，心绞痛病史（OR = 2.70；p = 0.006）、低教育水平（OR = 2.80，p = 0.012）和低收入（OR = 6.00，p = 0.005）仍然与女性性别显著相关。男性和女性在手术特征方面没有差异。
我们发现了临床特征和发病情况方面的几个性别差异。应向女性，尤其是社会经济地位较低的女性强调心绞痛发作时寻求紧急医疗救治的重要性。
