Department of internal medicine College of Medicine and Health Sciences UAE University Al Ain Abu Dhabi United Arab Emirates.
Department of Clinical Sciences College of Medicine King Saud University Riyadh Saudi Arabia.
J Am Heart Assoc. 2020 Feb 18;9(4):e013880. doi: 10.1161/JAHA.119.013880. Epub 2020 Feb 17.
Background No studies from the Arabian Gulf region have taken age into account when examining sex differences in ST-segment-elevation myocardial infarction (STEMI) presentation and outcomes. We examined the relationship between sex differences and presenting characteristics, revascularization procedures, and in-hospital mortality after accounting for age in patients hospitalized with STEMI in the Arabian Gulf region from 2005 to 2017. Methods and Results This study was a pooled analysis of 31 620 patients with a diagnosis of acute coronary syndrome enrolled in 7 Arabian Gulf registries. Of these, 15 532 patients aged ≥18 years were hospitalized with a primary diagnosis of STEMI. A multiple variable regression model was used to assess sex differences in revascularization, in-hospital mortality, and 1-year mortality. Odds ratios and 95% CIs were calculated. Women were, on average, 8.5 years older than men (mean age: 61.7 versus 53.2 years; absolute standard mean difference: 68.9%). The age-stratified analysis showed that younger women (aged <65 years) with STEMI were more likely to seek acute medical care and were less likely to receive thrombolytic therapies or primary percutaneous coronary intervention and guideline-recommended pharmacotherapy than men. Women had higher crude in-hospital mortality than men, driven mainly by younger age (46-55 years, odds ratio: 2.60 [95% CI, 1.80-3.7]; <0.001; 56-65 years, odds ratio: 2.32 [95% CI, 1.75-3.08]; <0.001; and 66-75 years, odds ratio: 1.79 [95% CI, 1.33-2.41]; <0.001). Younger women had higher adjusted in-hospital and 1-year mortality rates than younger men (<0.001). Conclusions Younger women (aged ≤65 years) with STEMI were less likely to receive guideline-recommended pharmacotherapy and revascularization than younger men during hospitalization and had higher in-hospital and 1-year mortality rates.
在阿拉伯海湾地区，尚无研究在考虑年龄的情况下，探讨 ST 段抬高型心肌梗死（STEMI）患者的性别差异及其表现和结局。我们在阿拉伯海湾地区 2005 年至 2017 年因 STEMI 住院的患者中，根据年龄考察了性别差异与表现特征、血运重建程序以及住院死亡率之间的关系。
本研究为对 7 个阿拉伯海湾注册中心登记的急性冠脉综合征患者共 31620 例进行的汇总分析。其中，15532 例年龄≥18 岁的患者被诊断为 STEMI 而住院治疗。采用多元回归模型评估血运重建、住院死亡率和 1 年死亡率的性别差异。计算比值比（OR）及其 95%置信区间（CI）。女性的平均年龄比男性大 8.5 岁（平均年龄：61.7 岁 vs. 53.2 岁；绝对标准均数差：68.9%）。年龄分层分析显示，年龄较轻（<65 岁）的 STEMI 女性比男性更有可能寻求急性医疗救治，更不可能接受溶栓治疗、直接经皮冠状动脉介入治疗以及指南推荐的药物治疗。女性的住院死亡率高于男性，这主要是由年龄较轻所致（46-55 岁，OR：2.60[95%CI，1.80-3.7]；<0.001；56-65 岁，OR：2.32[95%CI，1.75-3.08]；<0.001；66-75 岁，OR：1.79[95%CI，1.33-2.41]；<0.001）。年龄较轻的女性（<0.001）的住院和 1 年死亡率均高于年龄较轻的男性。
年龄较轻（≤65 岁）的 STEMI 女性在住院期间接受指南推荐的药物治疗和血运重建的可能性小于年龄较轻的男性，且住院和 1 年死亡率较高。
