Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy.
Department of Electrical and Computer Engineering, University of California, Los Angeles.
JAMA Intern Med. 2018 May 1;178(5):632-639. doi: 10.1001/jamainternmed.2018.0514.
Previous works have shown that women hospitalized with ST-segment elevation myocardial infarction (STEMI) have higher short-term mortality rates than men. However, it is unclear if these differences persist among patients undergoing contemporary primary percutaneous coronary intervention (PCI).
To investigate whether the risk of 30-day mortality after STEMI is higher in women than men and, if so, to assess the role of age, medications, and primary PCI in this excess of risk.
DESIGN, SETTING, AND PARTICIPANTS: From January 2010 to January 2016, a total of 8834 patients were hospitalized and received medical treatment for STEMI in 41 hospitals referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (NCT01218776).
Demographics, baseline characteristics, clinical profile, and pharmacological treatment within 24 hours and primary PCI.
Adjusted 30-day mortality rates estimated using inverse probability of treatment weighted (IPTW) logistic regression models.
There were 2657 women with a mean (SD) age of 66.1 (11.6) years and 6177 men with a mean (SD) age of 59.9 (11.7) years included in the study. Thirty-day mortality was significantly higher for women than for men (11.6% vs 6.0%, P < .001). The gap in sex-specific mortality narrowed if restricting the analysis to men and women undergoing primary PCI (7.1% vs 3.3%, P < .001). After multivariable adjustment for comorbidities and treatment covariates, women under 60 had higher early mortality risk than men of the same age category (OR, 1.88; 95% CI, 1.04-3.26; P = .02). The risk in the subgroups aged 60 to 74 years and over 75 years was not significantly different between sexes (OR, 1.28; 95% CI, 0.88-1.88; P = .19 and OR, 1.17; 95% CI, 0.80-1.73; P = .40; respectively). After IPTW adjustment for baseline clinical covariates, the relationship among sex, age category, and 30-day mortality was similar (OR, 1.56 [95% CI, 1.05-2.3]; OR, 1.49 [95% CI, 1.15-1.92]; and OR, 1.21 [95% CI, 0.93-1.57]; respectively).
Younger age was associated with higher 30-day mortality rates in women with STEMI even after adjustment for medications, primary PCI, and other coexisting comorbidities. This difference declines after age 60 and is no longer observed in oldest women.
先前的研究表明，因 ST 段抬高型心肌梗死（STEMI）住院的女性患者短期死亡率高于男性。然而，在接受当代经皮冠状动脉介入治疗（PCI）的患者中，这种差异是否仍然存在尚不清楚。
调查女性 STEMI 患者 30 天死亡率是否高于男性，如果是，评估年龄、药物和直接 PCI 在这种风险增加中的作用。
设计、地点和参与者：2010 年 1 月至 2016 年 1 月，共有 8834 名患者在 41 家医院因 STEMI 住院并接受治疗，并将数据提交给国际急性冠状动脉综合征转型国家调查（ISACS-TC）登记处（NCT01218776）。
人口统计学、基线特征、临床特征、24 小时内的药理学治疗和直接 PCI。
使用逆概率治疗加权（IPTW）逻辑回归模型估计调整后的 30 天死亡率。
研究纳入了 2657 名平均（标准差）年龄为 66.1（11.6）岁的女性和 6177 名平均（标准差）年龄为 59.9（11.7）岁的男性。女性 30 天死亡率明显高于男性（11.6%比 6.0%，P<0.001）。如果将分析仅限于接受直接 PCI 的男性和女性，男女之间的死亡率差异会缩小（7.1%比 3.3%，P<0.001）。在对合并症和治疗协变量进行多变量调整后，年龄小于 60 岁的女性与同年龄组的男性相比，早期死亡率风险更高（比值比，1.88；95%置信区间，1.04-3.26；P=0.02）。60-74 岁和 75 岁以上年龄组之间的性别风险差异无统计学意义（比值比，1.28；95%置信区间，0.88-1.88；P=0.19；比值比，1.17；95%置信区间，0.80-1.73；P=0.40）。在对基线临床协变量进行 IPTW 调整后，性别、年龄组和 30 天死亡率之间的关系相似（比值比，1.56[95%置信区间，1.05-2.3]；比值比，1.49[95%置信区间，1.15-1.92]；比值比，1.21[95%置信区间，0.93-1.57]）。
即使在调整药物、直接 PCI 和其他并存合并症后，STEMI 年轻女性的 30 天死亡率仍与年龄相关，且这一差异在 60 岁后下降，在最年长的女性中不再观察到。
