Department of Medicine, National University Health System, Singapore, 1E Kent Ridge Rd, NUHS Tower Block, Level 9 119228, Singapore.
Department of Medicine, National University Health System, Singapore, 1E Kent Ridge Rd, NUHS Tower Block, Level 9 119228, Singapore.
J Stroke Cerebrovasc Dis. 2022 Jan;31(1):106215. doi: 10.1016/j.jstrokecerebrovasdis.2021.106215. Epub 2021 Nov 20.
Gender differences historically exist in cardiovascular disease, with women experiencing higher rates of major adverse cardiovascular events. We investigated these trends in a contemporary Asian cohort, examining the impact of gender differences on cardiac mortality and ischemic stroke after primary percutaneous coronary intervention (PPCI) for ST elevation myocardial infarction (STEMI).
We analysed 3971 consecutive patients who underwent primary PCI for STEMI retrospectively. The primary outcome was cardiac mortality and ischemic stroke in-hospital, at one year and on longer-term follow up (median follow up 3.62 years, interquartile range 1.03-6.03 years).
There were 580 (14.6%) female patients and 3391 (85.4%) male patients. Female patients were older and had higher prevalence of hypertension, diabetes, previous strokes, and chronic kidney disease. Cardiac mortality was higher in female patients during in-hospital (15.5% vs. 6.2%), 1-year (17.4% vs. 7.0%) and longer term follow up (19.9% vs. 8.1%, log-rank test: p < 0.001). Similarly, females had higher incidence of ischemic stroke at in-hospital (2.6% vs. 1.0%), 1-year (3.6% vs. 1.4%) and in the longer-term (6.7% vs. 3.1%) as well (log-rank test: p < 0.001). Female gender remained an independent predictor of in-hospital cardiac mortality (HR 1.395, 95%CI 1.061-1.833, p=0.017) and on longer-term follow-up (HR 1.932 95%CI 1.212-3.080, p=0.006) even after adjusting for confounders.
Females were at higher risk of in-hospital and long-term cardiac mortality and ischemic stroke after PPCI for STEMI. Future studies are warranted to investigate the role of aggressive management of cardiovascular risk factors and follow-up to improve outcomes in the females with STEMI.
心血管疾病在历史上存在性别差异，女性发生主要不良心血管事件的比例更高。我们在当代亚洲队列中研究了这些趋势，考察了性别差异对 ST 段抬高型心肌梗死（STEMI）患者行经皮冠状动脉介入治疗（PPCI）后心源性死亡和缺血性卒中的影响。
我们回顾性分析了 3971 例连续接受 PPCI 治疗的 STEMI 患者。主要结局是住院期间、1 年及长期随访（中位随访 3.62 年，四分位距 1.03-6.03 年）的心源性死亡和缺血性卒中。
女性患者 580 例（14.6%），男性患者 3391 例（85.4%）。女性患者年龄较大，高血压、糖尿病、既往卒中和慢性肾脏病的患病率更高。住院期间（15.5%比 6.2%，log-rank 检验：p<0.001）、1 年时（17.4%比 7.0%，log-rank 检验：p<0.001）和长期随访时（19.9%比 8.1%，log-rank 检验：p<0.001）女性心源性死亡率更高。同样，女性患者住院期间（2.6%比 1.0%）、1 年时（3.6%比 1.4%）和长期随访时（6.7%比 3.1%）的缺血性卒中发生率也更高（log-rank 检验：p<0.001）。在校正混杂因素后，女性仍是住院期间心源性死亡（HR 1.395，95%CI 1.061-1.833，p=0.017）和长期随访时心源性死亡（HR 1.932，95%CI 1.212-3.080，p=0.006）的独立预测因素。
女性患者在 STEMI 患者行经皮冠状动脉介入治疗后，发生住院期间和长期心源性死亡和缺血性卒中的风险更高。需要进一步研究来探讨积极管理心血管危险因素和随访对改善 STEMI 女性患者结局的作用。
