Division of Cardiovascular Medicine, China Medical University Hospital, Taichung, Taiwan.
School of Medicine, College of Medicine, China Medical University, Taichung, Taiwan.
Int J Clin Pract. 2021 May;75(5):e14066. doi: 10.1111/ijcp.14066. Epub 2021 Mar 4.
Whether a sex difference exists in long-term cardiovascular (CV) outcomes after acute myocardial infarction (AMI) is worth exploration. This study is sought to investigate the relationships among sex, age, and the long-term prognosis after AMI.
This population-based retrospective cohort study used Taiwan's National Health Insurance Research Database to investigate the sex differences in in-hospital and long-term CV outcomes in patients with AMI. We enrolled patients who were first diagnosed with AMI from January 1, 2000 to December 31, 2013. The outcomes of interest included all-cause mortality, CV death, non-fatal stroke, non-fatal heart failure, and AMI recurrence during hospitalization and 5-year follow up. The CV outcomes were also analyzed by age stratification.
Overall, 201 921 patients with AMI were analyzed; 68.72% were men and 31.28% were women, with mean ages of 65.34 ± 14.12 and 73.05 ± 12.22 years, respectively. Major adverse cardiac events during hospitalization and up to 5 years were consistently greater in women than in men. Multivariable regression analysis revealed no sex difference existed in long-term all-cause and CV mortality. Men of all age groups consistently showed higher risk of both short- and long-term recurrence of AMI. Nonetheless, the female sex still independently predicted increased risk of non-fatal stroke and heart failure from hospitalization until 3-year follow up.
Women with AMI had poorer short-term and long-term outcomes. The sex differences in long-term all-cause and CV death disappear after multivariate analysis. Nonetheless, female AMI patients independently predicted higher risk of stroke and heart failure from hospitalization until a 3-year follow-up. To better understand the pathophysiology of female patients with AMI and develop more effective management, more studies in this field are necessary in the future.
急性心肌梗死（AMI）后长期心血管（CV）结局是否存在性别差异值得探讨。本研究旨在探讨性别、年龄与 AMI 后长期预后的关系。
本基于人群的回顾性队列研究使用台湾全民健康保险研究数据库，调查 AMI 患者住院期间和长期 CV 结局的性别差异。我们纳入了 2000 年 1 月 1 日至 2013 年 12 月 31 日首次诊断为 AMI 的患者。感兴趣的结局包括全因死亡率、CV 死亡率、非致死性卒中、非致死性心力衰竭和 AMI 复发，包括住院期间和 5 年随访期间。还按年龄分层分析 CV 结局。
共有 201921 例 AMI 患者纳入分析；68.72%为男性，31.28%为女性，平均年龄分别为 65.34±14.12 岁和 73.05±12.22 岁。住院期间和 5 年内主要不良心脏事件始终在女性中大于男性。多变量回归分析显示，长期全因和 CV 死亡率无性别差异。所有年龄组的男性均显示出短期和长期 AMI 复发的风险更高。然而，女性性别仍然独立预测从住院到 3 年随访期间非致死性卒中和心力衰竭的风险增加。
AMI 女性患者的短期和长期结局较差。多变量分析后，长期全因和 CV 死亡的性别差异消失。然而，女性 AMI 患者独立预测从住院到 3 年随访期间卒中和心力衰竭的风险增加。为了更好地了解女性 AMI 患者的病理生理学并制定更有效的管理策略，未来需要在该领域开展更多研究。
