Yale Cardiovascular Research Group, Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut.
Department of Surgery, New York University School of Medicine, New York, New York.
Am J Cardiol. 2021 May 15;147:23-32. doi: 10.1016/j.amjcard.2021.02.015. Epub 2021 Feb 25.
Gender disparities in ST-segment elevation myocardial infarction (STEMI) outcomes continue to be reported worldwide; however, the magnitude of this gap remains unknown. To evaluate gender-based discrepancies in clinical outcomes and identify the primary driving factors a global meta-analysis was performed. Studies were selected if they included all comers with STEMI, reported gender specific patient characteristics, treatments, and outcomes, according to the registered PROSPERO protocol: CRD42020161469. A total of 56 studies (705,098 patients, 31% females) were included. Females were older, had more comorbidities and received less antiplatelet therapy and primary percutaneous coronary intervention (PCI). Females experienced significantly longer delays to first medical contact (mean difference 42.5 min) and door-to-balloon time (mean difference 4.9 min). In-hospital, females had increased rates of mortality (odds ratio [OR] 1.91, 95% confidence interval [CI] 1.84 to 1.99, p <0.00001), repeat myocardial infarction (MI) (OR 1.25, 95% CI 1.00 to 1.56, p=0.05), stroke (OR 1.67, 95% CI 1.27 to 2.20, p <0.001), and major bleeding (OR 1.82, 95% CI 1.56 to 2.12, p <0.00001) compared with males. Older age at presentation was the primary driver of excess mortality in females, although other factors including lower rates of primary PCI and aspirin usage, and longer door-to-balloon times contributed. In contrast, excess rates of repeat MI and stroke in females appeared to be driven, at least in part, by lower use of primary PCI and P2Y12 inhibitors, respectively. In conclusion, despite improvements in STEMI care, women continue to have in-hospital rates of mortality, repeat MI, stroke, and major bleeding up to 2-fold higher than men. Gender disparities in in-hospital outcomes can largely be explained by age differences at presentation but comorbidities, delays to care and suboptimal treatment experienced by women may contribute to the gender gap.
全球范围内仍在报道 ST 段抬高型心肌梗死（STEMI）结局方面的性别差异；然而，这种差距的程度尚不清楚。为了评估临床结局方面的性别差异，并确定主要驱动因素，进行了一项全球荟萃分析。根据已注册的 PROSPERO 方案：CRD42020161469，选择纳入所有 STEMI 患者、报告性别特异性患者特征、治疗和结局的研究。共纳入 56 项研究（705098 例患者，31%为女性）。女性年龄更大，合并症更多，接受抗血小板治疗和经皮冠状动脉介入治疗（PCI）的比例更低。女性首次医疗接触（平均差异 42.5 分钟）和门球时间（平均差异 4.9 分钟）的延迟时间明显更长。住院期间，女性死亡率（比值比 [OR] 1.91，95%置信区间 [CI] 1.84 至 1.99，p<0.00001）、再次心肌梗死（OR 1.25，95%CI 1.00 至 1.56，p=0.05）、卒中和主要出血（OR 1.67，95%CI 1.27 至 2.20，p<0.001）的发生率更高。与男性相比，女性年龄较大是导致死亡率过高的主要因素，尽管其他因素包括较低的直接 PCI 使用率和阿司匹林使用率，以及较长的门球时间也有一定影响。相反，女性再次心肌梗死和卒中的发生率过高，至少部分原因是直接 PCI 和 P2Y12 抑制剂的使用率较低。总之，尽管 STEMI 治疗有所改善，但女性的住院死亡率、再次心肌梗死、卒中和大出血发生率仍高达男性的 2 倍。住院结局方面的性别差异在很大程度上可以用就诊时的年龄差异来解释，但女性的合并症、治疗延迟和治疗不充分也可能导致性别差异。
