Department of Medicine, Division of Cardiology, Montefiore Medical Center and Albert Einstein College of Medicine, Bronx, New York, USA.
Cardiology Section, San Francisco Veterans Affairs Health Care System, and Department of Medicine, University of California San Francisco, San Francisco, California, USA.
Clin Cardiol. 2020 Oct;43(10):1100-1109. doi: 10.1002/clc.23412. Epub 2020 Jul 28.
To compare outcomes by age and sex in race/ethnic minorities presenting with ST-elevation myocardial infarction (STEMI), as studies are limited.
We studied sociodemographics, management, and outcomes in 1208 STEMI patients evaluated for primary percutaneous coronary intervention between 2008 and 2014 at Montefiore Health System (Bronx, NY). A majority of patients self-identified as nonwhite, and nearly two-thirds were young (<45 years) or middle-aged (45-64 years).
Risk factors varied significantly across age groups; with more women and non-Hispanic whites, hypertension, diabetes, dyslipidemia, prior cardiovascular disease, non-sinus rhythm, and collagen vascular disease in the older age group (≥65 years); and higher body mass index, smoking, cocaine use, human immunodeficiency virus (HIV) infection and family history of heart disease in the young. Younger women had lower summary socioeconomic scores than younger men. Middle-aged women had more obesity and dysmetabolism, while men had more heavy alcohol use. There was greater disease severity with increasing age; with higher cardiac biomarkers, 3-vessel disease, cardiogenic shock, and coronary artery bypass grafting. Older patients had higher rates of death and death or readmission over 4.3 (interquartile range 2.4, 6.0) years of follow-up. Middle-aged women had higher rates of death or any readmission than men, but these differences were not significant after adjustment.
These findings indicate a high burden of risk factors in younger adults with STEMI from an inner-city community. Programs to target sociobehavioral factors in disadvantaged settings, including substance abuse, obesity, and risk of HIV, are necessary to more effectively address health disparities in STEMI and its adverse consequences.
由于研究有限，本研究旨在比较不同年龄和性别的少数族裔患者在 ST 段抬高型心肌梗死（STEMI）中的预后。
我们研究了 2008 年至 2014 年期间在 Montefiore 健康系统（纽约布朗克斯）接受直接经皮冠状动脉介入治疗的 1208 例 STEMI 患者的社会人口统计学、管理和结局。大多数患者自我认同为非白人，近三分之二的患者年龄较轻（<45 岁）或中年（45-64 岁）。
危险因素在不同年龄组之间差异显著；年龄较大的患者（≥65 岁）中女性和非西班牙裔白人、高血压、糖尿病、血脂异常、既往心血管疾病、非窦性节律和胶原血管疾病的比例较高；而年轻患者（<45 岁）中体重指数较高、吸烟、可卡因使用、人类免疫缺陷病毒（HIV）感染和心脏病家族史的比例较高。年轻女性的综合社会经济评分低于年轻男性。中年女性肥胖和代谢紊乱更为严重，而男性则酗酒更为严重。随着年龄的增长，疾病严重程度增加；心肌生物标志物升高、3 支血管病变、心源性休克和冠状动脉旁路移植术的发生率更高。老年患者的死亡率和死亡或再入院率在 4.3 年（四分位距 2.4，6.0）的随访期间更高。中年女性的死亡率或任何再入院率高于男性，但调整后差异无统计学意义。
这些发现表明，来自城市内城区的年轻 STEMI 患者存在较高的危险因素负担。在贫困地区，需要针对社会行为因素的项目，包括物质滥用、肥胖和 HIV 风险，以更有效地解决 STEMI 及其不良后果中的健康差异。
