性别差异与急性心肌梗死：2014 年至 2017 年德国全国真实生活分析。
Gender differences in acute myocardial infarction-A nationwide German real-life analysis from 2014 to 2017.
机构信息
University Hospital Muenster, Cardiol., Dept. of Cardiology I - Coronary and Peripheral Vascular Disease, Heart Failure, Muenster, Germany.
Institute of Biostatistics and Clinical Research, University of Muenster, Muenster, Germany.
出版信息
Clin Cardiol. 2021 Jul;44(7):890-898. doi: 10.1002/clc.23662. Epub 2021 Jun 1.
BACKGROUND
Female sex was reported to be associated with an unfavorable outcome in acute myocardial infarction (AMI). In this nationwide analysis we assessed sex differences in acute outcomes of AMI and recent trends in patient healthcare.
METHODS
We analyzed 875 735 German cases hospitalized with a main diagnosis of ST- (STEMI) and non ST-elevation myocardial infarction (NSTEMI) between January 01 2014 and December 31 2017 regarding morbidity, in-hospital mortality and treatments. A multivariable logistic regression model was designed to evaluate the use of interventions and their impact on in-hospital mortality.
RESULTS
STEMI cases decreased from 72 894 in 2014 to 68 213 in 2017, with 70% assignable to men. Female sex was associated with older age (74 vs. 62 years), and higher prevalence of cardiovascular risk factors such as chronic kidney disease (19.2% vs. 12.5%), hypertension (69.0% vs. 65.0%) and left ventricular heart failure (36.0% vs. 32.1%). In NSTEMI, female sex was also associated with older age (78 vs. 71 years), and higher prevalence of cardiovascular risk factors such as chronic kidney disease (29.7% vs. 23.9%), hypertension (77.4% vs. 74.5%) and left ventricular heart failure (40.5% vs. 36.4%). Overall, 74.3% of female and 81.3% of male STEMI cases received percutaneous coronary intervention (PCI, p < 0.001). In NSTEMI, PCI was performed in 40.8% of female and 52.0% of male cases (p < 0.001). In-hospital mortality was notably increased in female patients with STEMI (15.0% vs. 9.6%; p < 0.001; OR 1.07; 95% CI 1.03-1.10) and NSTEMI (8.3% vs. 6.3%; p < 0.001; OR 0.91; 95% CI 0.89-0.93) compared to males.
CONCLUSIONS
Our nationwide real-world data document that in-patient STEMI cases continue to decrease in women and men. The observed higher in-hospital mortality in women was largely attributed to a more unfavorable risk and age distribution rather than to female-intrinsic factors. Women with AMI continue to be less likely to receive revascularization therapies.
背景
有报道称，女性在急性心肌梗死（AMI）中预后不良。在这项全国性分析中，我们评估了 AMI 急性结局的性别差异以及患者医疗保健的近期趋势。
方法
我们分析了 2014 年 1 月 1 日至 2017 年 12 月 31 日期间因 ST 段抬高型心肌梗死（STEMI）和非 ST 段抬高型心肌梗死（NSTEMI）住院的 875735 例德国患者的发病率、住院死亡率和治疗情况。采用多变量逻辑回归模型评估干预措施的应用及其对住院死亡率的影响。
结果
STEMI 病例从 2014 年的 72894 例降至 2017 年的 68213 例，其中 70%为男性。女性与年龄较大（74 岁比 62 岁）和心血管危险因素的更高患病率相关，如慢性肾脏病（19.2%比 12.5%）、高血压（69.0%比 65.0%）和左心室心力衰竭（36.0%比 32.1%）。在 NSTEMI 中，女性也与年龄较大（78 岁比 71 岁）和心血管危险因素的更高患病率相关，如慢性肾脏病（29.7%比 23.9%）、高血压（77.4%比 74.5%）和左心室心力衰竭（40.5%比 36.4%）。总体而言，74.3%的女性 STEMI 病例和 81.3%的男性 STEMI 病例接受了经皮冠状动脉介入治疗（PCI，p<0.001）。在 NSTEMI 中，有 40.8%的女性和 52.0%的男性接受了 PCI（p<0.001）。女性 STEMI（15.0%比 9.6%；p<0.001；比值比 1.07；95%置信区间 1.03-1.10）和 NSTEMI（8.3%比 6.3%；p<0.001；比值比 0.91；95%置信区间 0.89-0.93）患者的住院死亡率明显高于男性。
结论
我们的全国真实世界数据表明，女性和男性的住院 STEMI 病例继续减少。女性住院死亡率较高主要归因于风险和年龄分布更为不利，而不是女性内在因素。AMI 女性患者接受血运重建治疗的可能性仍然较低。
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