Sun Yihong, Feng Lin, Li Xian, Gao Runlin, Wu Yangfeng
China-Japan Friendship Hospital, Beijing, China.
Peking University Clinical Research Institute, Beijing, China.
Int J Cardiol. 2020 Jul 15;311:1-6. doi: 10.1016/j.ijcard.2020.03.043. Epub 2020 Mar 20.
We aimed to assess sex difference in developing major adverse cardiovascular events (MACEs) after discharge and factors associated with the gender disparity among AMI survivors.
We selected the patients hospitalized with either NSTEMI or STEMI from 101 Chinese centers in the CPACS 3 study. We compared sex differences in MACEs and mortality in 6 months after discharge using a Cox proportional hazards model, following sequential adjustment for covariates.
8958 patients with AMI were included and 30.3% were women. Overall, the crude rate of MACEs at 6 month for women were significantly higher than men (6.5% vs 4.5%; hazard ratio (HR) =1.47; 95% CI, 1.21-1.77). Women also had significantly higher total mortality compared to men (4.4% vs 2.7%; HR = 1.65; 95% CI, 1.30-2.09). Among possible explanatory factors, patients' cardiovascular risk profile might explain 53%, age 38%, low level of education and socioeconomic status 32%. Interestingly, medications at discharge did not contribute to the sex disparity in 6-month risk of MACEs. These factors could explain a similar proportion of the gender disparity in total death. All together, these factors could explain all the disparity in the risk of both MACEs (HR = 1.05,95% CI, 0.85-1.31) and total death (HR = 1.00,95% CI,0.76-1.30).
The gender disparity in MACEs and total death among AMI patients continues at 6 months after discharged surviving. Multiple factors could explain the higher risk for women, including poorer cardiovascular risk factor profile, older age and lower socioeconomic status.
CPACS-3 was registered on www.clinicaltrails.gov, and the registration number is NCT01398228.
我们旨在评估急性心肌梗死（AMI）幸存者出院后发生主要不良心血管事件（MACE）的性别差异以及与性别差异相关的因素。
我们从CPACS 3研究中的101个中国中心选取了因非ST段抬高型心肌梗死（NSTEMI）或ST段抬高型心肌梗死（STEMI）住院的患者。我们使用Cox比例风险模型，在对协变量进行序贯调整后，比较出院后6个月内MACE和死亡率的性别差异。
纳入8958例AMI患者，其中30.3%为女性。总体而言，女性6个月时MACE的粗发生率显著高于男性（6.5%对4.5%；风险比（HR）=1.47；95%置信区间，1.21 - 1.77）。女性的总死亡率也显著高于男性（4.4%对2.7%；HR = 1.65；95%置信区间，1.30 - 2.09）。在可能的解释因素中，患者的心血管风险状况可能解释53%，年龄解释38%，低教育水平和社会经济地位解释32%。有趣的是，出院时的用药情况对6个月MACE风险的性别差异没有影响。这些因素对总死亡的性别差异也能解释相似的比例。总体而言，这些因素可以解释MACE风险（HR = 1.05，95%置信区间，0.85 - 1.31）和总死亡风险（HR = 1.00，95%置信区间，0.76 - 1.30）的所有差异。
AMI患者出院存活6个月后，MACE和总死亡的性别差异仍然存在。多种因素可以解释女性风险较高的原因，包括较差的心血管危险因素状况、年龄较大和社会经济地位较低。
