Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN.
Department of Cardiovascular Medicine, University of Kentucky, Lexington, KY.
Mayo Clin Proc. 2021 Feb;96(2):332-341. doi: 10.1016/j.mayocp.2020.04.048. Epub 2021 Jan 20.
To assess the impact of female sex on the incidence, management, and outcomes of myocardial infarction (MI) in different age groups.
Patients admitted with ST-elevation MI (STEMI) and non-ST-elevation MI (NSTEMI), between January 1, 2003, and December 31, 2015, were identified in the National Inpatient Sample. We compared STEMI and NSTEMI rates, management patterns, and in-hospital morbidity and mortality in men and women stratified into 4 age groups (<45, 45 to 64, 65 to 84, and ≥85 years of age).
A total of 6,720,639 weighted hospitalizations for MI (79.8% NSTEMI, and 20.2% STEMI) were included. The incidence rate of hospitalizations for MI was lower in women than men across all age groups. Women were less likely than men to undergo coronary angiography, revascularization, or to use circulatory-support devices. These differences were consistent across all age groups. Adjusted odds of death for women (vs men) varied by age: odds ratio (95% confidence interval) 1.08 (0.97 to 1.20), 1.05 (1.02 to 1.08), 0.92 (0.91 to 0.94), and 0.86 (0.85 to 0.88) for NSTEMI, and 1.15 (1.04 to 1.27), 1.22 (1.18 to 1.26), 1.09 (1.06 to 1.11), and 0.97 (0.94 to 0.99), for STEMI, in age groups (<45, 45 to 64, 65 to 84, and ≥85), respectively. The magnitude of differences in complications between men and women was higher in younger and middle-age patients.
Compared with men, women have lower incidence of MI and less likelihood of undergoing invasive treatment regardless of age. However, post-MI outcomes are age specific. The negative impact of female sex on most outcomes was most pronounced in young and middle-aged women.
评估女性性别对不同年龄组心肌梗死（MI）发病率、治疗和结局的影响。
在全国住院患者样本中，确定了 2003 年 1 月 1 日至 2015 年 12 月 31 日期间因 ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型心肌梗死（NSTEMI）入院的患者。我们比较了按 4 个年龄组（<45 岁、45 至 64 岁、65 至 84 岁和≥85 岁）分层的男性和女性的 STEMI 和 NSTEMI 发生率、治疗模式以及院内发病率和死亡率。
共纳入了 6720639 例 MI 加权住院患者（79.8%为 NSTEMI，20.2%为 STEMI）。在所有年龄组中，女性的 MI 住院率均低于男性。与男性相比，女性接受冠状动脉造影、血运重建或使用循环支持装置的可能性较小。这些差异在所有年龄组中均一致。女性（与男性相比）死亡的调整优势比（95%置信区间）因年龄而异：比值比（95%置信区间）分别为 NSTEMI 为 1.08（0.97 至 1.20）、1.05（1.02 至 1.08）、0.92（0.91 至 0.94）和 0.86（0.85 至 0.88），STEMI 为 1.15（1.04 至 1.27）、1.22（1.18 至 1.26）、1.09（1.06 至 1.11）和 0.97（0.94 至 0.99）。在年龄组（<45 岁、45 至 64 岁、65 至 84 岁和≥85 岁）中。男性和女性之间并发症差异的幅度在年轻和中年患者中更高。
与男性相比，女性无论年龄大小，MI 发生率较低，接受侵入性治疗的可能性较低。然而，MI 后的结局是特定于年龄的。女性性别对大多数结局的负面影响在年轻和中年女性中最为明显。
