Nagumo Sakura, Mori Hiroyoshi, Maeda Atsuo, Akashi Yoshihiro J, Ako Junya, Ikari Yuji, Ebina Toshiaki, Sato Naoki, Tamura Kouichi, Namiki Atsuo, Fukui Kazuki, Michishita Ichiro, Kimura Kazuo, Suzuki Hiroshi
Division of Cardiology, Department of Internal Medicine, Showa University Fujigaoka Hospital Yokohama Japan.
Department of Emergency and Disaster Medicine, Showa University Hospital Tokyo Japan.
Circ Rep. 2019 Jul 9;1(8):313-319. doi: 10.1253/circrep.CR-19-0041.
Despite the drastic advances in clinical care for patients with acute ST-elevation myocardial infarction (STEMI), female STEMI patients have higher in-hospital mortality rates than male patients. This study assessed the influence of sex on in-hospital mortality in STEMI patients in Kanagawa Prefecture, Japan. From October 2015 to June 2018, 2,491 consecutive STEMI patients (23.9% female) who presented to hospital in the 24 h after symptom onset were analyzed. The female patients were 9 years older and less frequently had diabetes, smoking and prior MI than male patients. Pre-hospital managements, including prehospital 12-lead electrocardiography, and symptom-to-door time were similar between the sexes. A door-to-device time ≤90 min was achieved in 61.3% of female cases and in 65.0% of male cases (P=0.13). Reperfusion therapy was provided to 94.6% of female and 97.6% of male patients (P<0.001). In-hospital mortality rate was not significantly different between female and male patients (6.6% vs. 7.8%, P=0.37). On multivariate logistic regression analysis, female sex itself was not associated with in-hospital mortality (OR, 1.52; 95% CI: 0.67-3.47, P=0.32). There was no sex discrepancy in the in-hospital mortality of STEMI patients in this study. Guideline-based treatment, such as advanced pre-hospital management and a high use of reperfusion therapy might have attenuated the sex-related differences in the in-hospital mortality.
尽管急性ST段抬高型心肌梗死（STEMI）患者的临床护理取得了巨大进展，但女性STEMI患者的院内死亡率高于男性患者。本研究评估了性别对日本神奈川县STEMI患者院内死亡率的影响。2015年10月至2018年6月，对症状发作后24小时内入院的2491例连续STEMI患者（23.9%为女性）进行了分析。女性患者比男性患者大9岁，患糖尿病、吸烟和既往心肌梗死的频率更低。两性之间的院前管理，包括院前12导联心电图和症状到入院时间相似。61.3%的女性病例和65.0%的男性病例实现了门到设备时间≤90分钟（P=0.13）。94.6%的女性患者和97.6%的男性患者接受了再灌注治疗（P<0.001）。女性和男性患者的院内死亡率无显著差异（6.6%对7.8%，P=0.37）。多因素逻辑回归分析显示，女性本身与院内死亡率无关（OR，1.52；95%CI：0.67-3.47，P=0.32）。本研究中STEMI患者的院内死亡率不存在性别差异。基于指南的治疗，如先进的院前管理和高比例的再灌注治疗，可能减弱了院内死亡率的性别相关差异。
