Department of Health, Medicine and Caring Sciences and Department of Cardiology, Linköping University, Linköping, Sweden.
Department of Medical Sciences, Cardiology, Uppsala University, Uppsala, Sweden; Uppsala Clinical Research Center, Uppsala University, Uppsala, Sweden.
Am Heart J. 2021 Jul;237:13-24. doi: 10.1016/j.ahj.2021.03.001. Epub 2021 Mar 6.
The purpose of this study is to investigate the impact of oxygen therapy on cardiovascular outcomes in relation to sex in patients with confirmed myocardial infarction (MI).
The DETermination of the role of Oxygen in suspected Acute Myocardial Infarction trial randomized 6,629 patients to oxygen at 6 L/min for 6-12 hours or ambient air. In the present subgroup analysis including 5,010 patients (1,388 women and 3,622 men) with confirmed MI, we report the effect of supplemental oxygen on the composite of all-cause death, rehospitalization with MI, or heart failure at long-term follow-up, stratified according to sex.
Event rate for the composite endpoint was 18.1% in women allocated to oxygen, compared to 21.4% in women allocated to ambient air (hazard ratio [HR] 0.83, 95% confidence interval [CI] 0.65-1.05). In men, the incidence was 13.6% in patients allocated to oxygen compared to 13.3% in patients allocated to ambient air (HR 1.03, 95% CI 0.86-1.23). No significant interaction in relation to sex was found (P= .16). Irrespective of allocated treatment, the composite endpoint occurred more often in women compared to men (19.7 vs 13.4%, HR 1.51; 95% CI, 1.30-1.75). After adjustment for age alone, there was no difference between the sexes (HR 1.06, 95% CI 0.91-1.24), which remained consistent after multivariate adjustment.
Oxygen therapy in normoxemic MI patients did not significantly affect all-cause mortality or rehospitalization for MI or heart failure in women or men. The observed worse outcome in women was explained by differences in baseline characteristics, especially age.
本研究旨在探讨氧疗对确诊心肌梗死（MI）患者心血管结局的影响与性别之间的关系。
DETermination of the role of Oxygen in suspected Acute Myocardial Infarction 试验将 6629 例患者随机分为氧疗组（6L/min 吸氧 6-12 小时）和空气组。本亚组分析纳入了 5010 例确诊 MI 患者（女性 1388 例，男性 3622 例），报告了补充氧气对长期随访时全因死亡、MI 再住院或心力衰竭复合终点的影响，并按性别分层。
女性氧疗组的复合终点发生率为 18.1%，而女性空气组为 21.4%（危险比 [HR] 0.83，95%置信区间 [CI] 0.65-1.05）。男性中，氧疗组的发生率为 13.6%，空气组为 13.3%（HR 1.03，95% CI 0.86-1.23）。未发现与性别相关的显著交互作用（P=.16）。无论分配的治疗如何，女性的复合终点发生率均高于男性（19.7% vs 13.4%，HR 1.51；95% CI，1.30-1.75）。仅调整年龄后，两性之间无差异（HR 1.06，95% CI 0.91-1.24），多变量调整后结果一致。
在氧合正常的 MI 患者中，氧疗并未显著影响女性或男性的全因死亡率或因 MI 或心力衰竭再住院。女性观察到的较差结局可由基线特征差异（尤其是年龄）解释。
