Ladwig Karl-Heinz, Fang Xiaoyan, Wolf Kathrin, Hoschar Sophia, Albarqouni Loai, Ronel Joram, Meinertz Thomas, Spieler Derek, Laugwitz Karl-Ludwig, Schunkert Heribert
Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany; Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK), Partnersite Munich, Germany.
Institute of Epidemiology II, Mental Health Research Unit, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany; Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
Am J Cardiol. 2017 Dec 15;120(12):2128-2134. doi: 10.1016/j.amjcard.2017.09.005. Epub 2017 Sep 18.
Early administration of reperfusion therapy in acute ST-elevation myocardial infarctions (STEMI) is crucial to reduce mortality. Although female sex and old age are key factors contributing to an inadequate long prehospital delay time, little is known whether women ≥65 years are a particular risk population. Hence, we studied the interaction of sex and age (<65 years or ≥65 years) and the contribution of chest pain to delay time during STEMI. Bedside interview data were collected in 619 STEMI patients from the Munich Examination of Delay in Patients Experiencing Acute Myocardial Infarction (MEDEA) study. Sex and age group stratification disclosed an excess delay risk for women ≥65 years, accounting for a 2.39 (95% confidence interval (CI) 1.39 to 4.10)-fold higher odds to delay longer than 2 hours compared with all other patient groups including younger women (p ≤0.002). Median delay time was 266 minutes in women ≥65 years and 148 minutes in younger women (p <0.001). Chest pain during STEMI had the lowest frequency both in women (81%) and men ≥65 years (83%) and the highest frequency (95%) in younger women. Experiencing non-chest pain was 2.32-fold (95% CI, 1.20 to 4.46, p <0.05) higher in women ≥65 years than in all other patients. Mediation analysis disclosed that the effect accounted for only 9% of the variance. Age specific educational strategies targeting women ≥65 years at risk are urgently needed. To tailor adequate strategies, more research is required to understand age- and sex driven barriers to timely identification of ischemic symptoms.
在急性ST段抬高型心肌梗死（STEMI）中尽早进行再灌注治疗对于降低死亡率至关重要。尽管女性和老年是导致院前延迟时间过长的关键因素，但对于65岁及以上的女性是否为特殊的高危人群却知之甚少。因此，我们研究了性别和年龄（<65岁或≥65岁）的相互作用以及胸痛对STEMI期间延迟时间的影响。我们从慕尼黑急性心肌梗死患者延迟情况检查（MEDEA）研究中收集了619例STEMI患者的床边访谈数据。按性别和年龄组分层显示，65岁及以上女性的延迟风险更高，与包括年轻女性在内的所有其他患者组相比，延迟超过2小时的几率高出2.39倍（95%置信区间（CI）为1.39至4.10）（p≤0.002）。65岁及以上女性的中位延迟时间为266分钟，年轻女性为148分钟（p<0.001）。STEMI期间胸痛的发生率在女性（81%）和65岁及以上男性（83%）中最低，在年轻女性中最高（95%）。65岁及以上女性出现非胸痛症状的几率比所有其他患者高2.32倍（95%CI为1.20至4.46，p<0.05）。中介分析显示，该效应仅占方差的9%。迫切需要针对65岁及以上高危女性制定特定年龄的教育策略。为了制定适当的策略，需要更多的研究来了解年龄和性别驱动的及时识别缺血症状的障碍。
