Shih Jhih-Yuan, Chen Zhih-Cherng, Chang Hsien-Yuan, Liu Yen-Wen, Ho Chung-Han, Chang Wei-Ting
Department of Cardiology, Chi Mei Medical Center, Tainan, Taiwan.
Department of Pharmacy, Chia Nan University of Pharmacy & Science, Tainan, Taiwan.
Int J Cardiol Heart Vasc. 2019 Mar 28;23:100350. doi: 10.1016/j.ijcha.2019.100350. eCollection 2019 Jun.
How sex and age influence post-myocardial infarction (post-MI) outcomes remains unclear. This study evaluated the influence of sex and age on drug therapy, echocardiographic parameters, and outcomes in post-MI patients undergoing percutaneous coronary intervention (PCI).
We retrospectively enrolled 643 patients with first acute MI who underwent successful PCI and two echocardiographic examinations within 1 year after MI. Clinical characteristics and 4-year follow-up outcomes were compared between sexes and age groups. Primary endpoints were cardiovascular mortality and hospitalization for heart failure (HF).
Compared with males, female patients with MI, particularly older females, had more systemic diseases. Younger females received fewer guideline-directed therapies. Older patients presented with higher left ventricular volume and mass index but no significant differences in left ventricular ejection fraction. The Kaplan-Meier analysis revealed increased mortality in both younger and older females. Elderly patients, particularly older females, exhibited significantly higher post-MI HF incidence but no difference in recurrent MI, ventricular arrhythmia, or revascularization.
In MI patients receiving PCI, outcome differences between sexes are age-dependent. Age influences outcome more heavily in females than in males. Females are likely to exhibit worse overall survival, and older females are at higher risk of post-MI HF.
性别和年龄如何影响心肌梗死后（post-MI）的预后仍不清楚。本研究评估了性别和年龄对接受经皮冠状动脉介入治疗（PCI）的心肌梗死后患者药物治疗、超声心动图参数及预后的影响。
我们回顾性纳入了643例首次急性心肌梗死且在心肌梗死后1年内成功接受PCI并进行了两次超声心动图检查的患者。比较了不同性别和年龄组的临床特征及4年随访结果。主要终点为心血管死亡率和因心力衰竭（HF）住院。
与男性相比，心肌梗死女性患者，尤其是老年女性，有更多的全身性疾病。年轻女性接受的指南指导治疗较少。老年患者左心室容积和质量指数较高，但左心室射血分数无显著差异。Kaplan-Meier分析显示年轻和老年女性的死亡率均增加。老年患者，尤其是老年女性，心肌梗死后HF发病率显著更高，但在再发心肌梗死、室性心律失常或血运重建方面无差异。
在接受PCI的心肌梗死患者中，性别间的预后差异与年龄有关。年龄对女性预后的影响比对男性更严重。女性总体生存率可能更差，老年女性心肌梗死后HF风险更高。
