性别与急性 ST 段抬高型心肌梗死合并急性心力衰竭患者临床结局的关系。
Association of gender with clinical outcomes of patients with acute ST-segment elevation myocardial infarction presenting with acute heart failure.
机构信息
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia, Indonesian Cardiovascular Research Center.
Department of Cardiology and Vascular Medicine, Faculty of Medicine, University of Indonesia.
出版信息
Coron Artery Dis. 2021 Jan;32(1):17-24. doi: 10.1097/MCA.0000000000000892.
BACKGROUND
There is limited data evaluating the sex differences in outcomes of patients with ST-segment elevation myocardial infarction presenting with acute heart failure. We compared the outcomes between women and men with ST-segment elevation myocardial infarction presenting with acute heart failure (Killip classification ≥II).
METHOD
All ST-segment elevation myocardial infarction patients presenting to the emergency department of a cardiovascular center in Jakarta, Indonesia, from 1 February 2011 to 30 August 2019 were retrospectively analyzed.
RESULTS
Of 6557 patients recorded, 929 were women, and 276 (4.2%) presented with acute heart failure. Compared with men with acute heart failure (N = 1540), women who presented with acute heart failure were older (63 ± 10 vs. 57 ± 10 years, P < 0.001), had a greater proportion of thrombolysis in myocardial infarction risk score >4 (85% vs. 73%, P < 0.001), received fewer primary angioplasty and in-hospital fibrinolytic therapy (40% vs. 48%, P = 0.004 and 1.1% versus 3.5%, P = 0.03, respectively), and had longer median door-to-device and total ischemia times (96 vs. 83 minutes, P = 0.001, and 516 versus 464 minutes, P = 0.02, respectively). Multivariate analysis showed that women and men with acute heart failure were each associated with increased risk of in-hospital mortality (odds ratio: 4.70; 95% confidence interval: 3.28-6.73 and odds ratio: 4.75; 95% confidence interval: 3.84-5.88, respectively), and this remained relatively unchanged even among patients with acute heart failure who had undergone reperfusion therapy (odds ratio: 5.35; 95% confidence interval: 3.01-9.47 and odds ratio: 5.19; 95% confidence interval: 3.80-7.08, respectively).
CONCLUSION
In our population, women with ST-segment elevation myocardial infarction presenting with acute heart failure had relatively similar risk of early mortality with their male counterpart (≈5-fold), thus should receive evidence-based treatment.
背景
目前评估 ST 段抬高型心肌梗死（STEMI）合并急性心力衰竭患者性别差异结局的数据有限。我们比较了 STEMI 合并急性心力衰竭（Killip 分级≥II 级）患者的性别差异。
方法
回顾性分析 2011 年 2 月 1 日至 2019 年 8 月 30 日期间印度尼西亚雅加达心血管中心急诊科就诊的所有 STEMI 患者。
结果
在记录的 6557 例患者中，有 929 例为女性，其中 276 例（4.2%）出现急性心力衰竭。与急性心力衰竭的男性患者（N=1540 例）相比，急性心力衰竭的女性患者年龄更大（63±10 岁 vs. 57±10 岁，P＜0.001），溶栓治疗心肌梗死风险评分＞4 分的比例更高（85% vs. 73%，P＜0.001），接受直接经皮冠状动脉介入治疗和院内溶栓治疗的比例更低（40% vs. 48%，P=0.004 和 1.1% vs. 3.5%，P=0.03），门球时间和总缺血时间更长（96 分钟 vs. 83 分钟，P=0.001 和 516 分钟 vs. 464 分钟，P=0.02）。多变量分析显示，急性心力衰竭的女性和男性患者的院内死亡率均升高（比值比：4.70；95%置信区间：3.28-6.73 和比值比：4.75；95%置信区间：3.84-5.88），即使在接受再灌注治疗的急性心力衰竭患者中，这种风险也相对不变（比值比：5.35；95%置信区间：3.01-9.47 和比值比：5.19；95%置信区间：3.80-7.08）。
结论
在我们的人群中，STEMI 合并急性心力衰竭的女性患者与男性患者的早期死亡率风险相当（≈5 倍），因此应接受基于证据的治疗。
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