Department of Cardiology, CHU Lariboisière, AP-HP, Paris VII University, INSERM UMRS 942, Paris, France.
Department of Internal Medicine and Chest Diseases, EA3878, CIC-INSERM1412, Brest University Hospital, European University of Occidental Brittany, Brest, France.
Int J Cardiol. 2018 Jul 1;262:1-8. doi: 10.1016/j.ijcard.2018.02.044. Epub 2018 Feb 13.
Women show greater mortality after acute myocardial infarction. We decided to investigate whether gender affects delays and impacts in-hospital mortality in a large population.
We performed a patient-level analysis of 7 French MI registries from different regions from January 2005 to December 2012. All patients with acute STEMI were included within 12 h from symptom onset and a first medical contact with a mobile intensive care unit an emergency department of a hospital with percutaneous coronary intervention facility. Primary study outcomes were STEMI, patient and system, delays. Secondary outcome was in-hospital mortality. 16,733 patients were included with 4021 females (24%). Women were significantly older (mean age 70.6 vs 60.6), with higher diabetes (19.6% vs 15.4%) and hypertension rates (58.7% vs 38.8%). Patient delay was longer in women with adjusted mean difference of 14.4 min (p < 0.001); system delay did not differ. In-hospital death occurred 3 times more in women. This disadvantage persisted strongly adjusting for age, therapeutic strategy and delay with a 1.85 (1.32-2.61) adjusted hazard ratio.
This overview of 16,733 real-life consecutive STEMI patients in prospective registries over an extensive period strongly indicates gender-related discrepancies, highlighting clinically relevant delays in seeking medical attention. However, higher in-hospital mortality was not totally explained by clinical characteristics or delays. Dedicated studies of specific mechanisms underlying this female disadvantage are mandatory to reduce this gender gap.
女性在急性心肌梗死（AMI）后死亡率更高。我们决定研究在一个大人群中，性别是否会影响住院死亡率的延迟和影响。
我们对 2005 年 1 月至 2012 年 12 月期间来自法国不同地区的 7 个 AMI 注册中心进行了患者水平分析。所有符合急性 ST 段抬高型心肌梗死（STEMI）标准的患者均在发病后 12 小时内纳入，通过移动重症监护单元首次与医疗机构（具有经皮冠状动脉介入治疗能力的医院的急诊部门）取得联系。主要研究结局是 STEMI、患者和系统延迟。次要结局是住院死亡率。共纳入 16733 例患者，其中 4021 例为女性（24%）。女性患者年龄明显较大（平均年龄 70.6 岁 vs 60.6 岁），糖尿病（19.6% vs 15.4%）和高血压（58.7% vs 38.8%）发生率更高。女性患者的就诊延迟时间更长，调整后的平均差异为 14.4 分钟（p<0.001）；系统延迟无差异。女性住院死亡率高出三倍。在调整年龄、治疗策略和延迟因素后，这种劣势仍然存在，调整后的风险比为 1.85（1.32-2.61）。
这项对 16733 例连续的 STEMI 患者在广泛时期内进行的前瞻性注册研究的综述，强烈表明存在与性别相关的差异，突出了在寻求医疗帮助方面存在明显的延迟。然而，较高的住院死亡率并不能完全用临床特征或延迟来解释。必须进行专门的研究，以了解导致女性处于不利地位的具体机制，从而缩小这种性别差距。
