2 型糖尿病对心肌梗死发病率和结局的影响是否存在性别差异？利用医院出院数据的配对分析。
Are there sex differences in the effect of type 2 diabetes in the incidence and outcomes of myocardial infarction? A matched-pair analysis using hospital discharge data.
机构信息
Department of Public Health & Maternal and Child Health, Faculty of Medicine, Universidad Complutense de Madrid, Madrid, Spain.
Preventive Medicine and Public Health Teaching and Research Unit, Health Sciences Faculty, Rey Juan Carlos University, Alcorcón, Madrid, Spain.
出版信息
Cardiovasc Diabetol. 2021 Apr 22;20(1):81. doi: 10.1186/s12933-021-01273-y.
BACKGROUND
To analyze incidence, use of therapeutic procedures, and in-hospital outcomes in patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) according to the presence of type 2 diabetes (T2DM) in Spain (2016-2018) and to investigate sex differences.
METHODS
Using the Spanish National Hospital Discharge Database, we estimated the incidence of myocardial infarctions (MI) in men and women with and without T2DM aged ≥ 40 years. We analyzed comorbidity, procedures, and outcomes. We matched each man and woman with T2DM with a non-T2DM man and woman of identical age, MI code, and year of hospitalization. Propensity score matching was used to compare men and women with T2DM.
RESULTS
MI was coded in 109,759 men and 44,589 women (30.47% with T2DM). The adjusted incidence of STEMI (IRR 2.32; 95% CI 2.28-2.36) and NSTEMI (IRR 2.91; 95% CI 2.88-2.94) was higher in T2DM than non-T2DM patients, with higher IRRs for NSTEMI in both sexes. The incidence of STEMI and NSTEMI was higher in men with T2DM than in women with T2DM. After matching, percutaneous coronary intervention (PCI) was less frequent among T2DM men than non-T2DM men who had STEMI and NSTEMI. Women with T2DM and STEMI less frequently had a code for PCI that matched that of non-T2DM women. In-hospital mortality (IHM) was higher among T2DM women with STEMI and NSTEMI than in matched non-T2DM women. In men, IHM was higher only for NSTEMI. Propensity score matching showed higher use of PCI and coronary artery bypass graft and lower IHM among men with T2DM than women with T2DM for both STEMI and NSTEMI.
CONCLUSIONS
T2DM is associated with a higher incidence of STEMI and NSTEMI in both sexes. Men with T2DM had higher incidence rates of STEMI and NSTEMI than women with T2DM. Having T2DM increased the risk of IHM after STEMI and NSTEMI among women and among men only for NSTEMI. PCI appears to be less frequently used in T2DM patients After STEMI and NSTEMI, women with T2DM less frequently undergo revascularization procedures and have a higher mortality risk than T2DM men.
背景
分析西班牙 2016-2018 年 ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型心肌梗死（NSTEMI）患者中是否存在 2 型糖尿病（T2DM）的发生率、治疗方法和院内结局，并探讨性别差异。
方法
使用西班牙国家住院数据库，我们估计了≥40 岁的男性和女性中患有和不患有 T2DM 的心肌梗死（MI）的发生率。我们分析了合并症、程序和结局。我们将每位患有 T2DM 的男性和女性与年龄、MI 编码和住院年份相同的非 T2DM 男性和女性相匹配。采用倾向评分匹配比较了患有 T2DM 的男性和女性。
结果
在 109759 名男性和 44589 名女性中编码了 MI（30.47%患有 T2DM）。与非 T2DM 患者相比，T2DM 患者 STEMI（调整后的发病率比 [IRR]2.32；95%置信区间 [CI]2.28-2.36）和 NSTEMI（IRR2.91；95%CI2.88-2.94）的发生率更高，且两性 NSTEMI 的 IRR 更高。与患有 T2DM 的女性相比，患有 T2DM 的男性 STEMI 和 NSTEMI 的发生率更高。匹配后，患有 STEMI 和 NSTEMI 的 T2DM 男性接受经皮冠状动脉介入治疗（PCI）的频率低于非 T2DM 男性。患有 T2DM 的 STEMI 女性接受与非 T2DM 女性相匹配的 PCI 编码的可能性较小。与 STEMI 和 NSTEMI 匹配的非 T2DM 女性相比，患有 STEMI 和 NSTEMI 的 T2DM 女性的院内死亡率（IHM）更高。对于男性，仅 NSTEMI 的 IHM 更高。倾向评分匹配显示，与女性相比，STEMI 和 NSTEMI 患者中，T2DM 男性接受 PCI 和冠状动脉旁路移植术的比例更高，IHM 更低。
结论
T2DM 与两性 STEMI 和 NSTEMI 的发生率升高有关。与患有 T2DM 的女性相比，患有 T2DM 的男性 STEMI 和 NSTEMI 的发生率更高。STEMI 和 NSTEMI 后，女性 T2DM 的 IHM 风险高于男性，男性 T2DM 的 IHM 风险仅在 NSTEMI 后增加。在 STEMI 和 NSTEMI 后，T2DM 患者接受 PCI 的频率似乎较低。与 T2DM 男性相比，患有 T2DM 的女性接受血运重建术的可能性较小，死亡率风险更高。
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