Mathew Anoop, Hong Yongzhe, Yogasundaram Haran, Nagendran Jeevan, Punnoose Eapen, Ashraf S M, Fischer Louie, Abdullakutty Jabir, Pisharody Sunil, Bainey Kevin, Graham Michelle
Division of Cardiology, University of Alberta Hospital, Edmonton, Alberta, Canada.
Division of Cardiology, Malankara Orthodox Syrian Christian Medical College Hospital, Kolenchery, Kerala, India.
CJC Open. 2021 Oct 2;3(12 Suppl):S71-S80. doi: 10.1016/j.cjco.2021.09.023. eCollection 2021 Dec.
Sex-based differences have been found in outcomes following ST-segment myocardial infarction (STEMI). Studies assessing sex-based differences in STEMI among Indian patients have reported conflicting results.
A prospective multicenter registry of consecutive patients with STEMI who presented to percutaneous coronary intervention (PCI)-capable hospitals in the Indian state of Kerala between June 2013 and March 2017 was used to assess 1-year outcomes. The primary endpoint was a composite of major adverse cardiac events (MACE), including death, stroke, nonfatal myocardial infarction, and rehospitalization for heart failure. Outcomes of 2 sex-based propensity score-matched groups were compared.
We included 3194 patients (19.4% women). Women presenting with STEMI were older, had more traditional cardiovascular risk factors, and were more likely to be classified as living in poverty. After propensity-score matching, women experienced greater incidence of MACE (20.9% vs 14.3%, < 0.01), primarily driven by increased 1-year mortality (14.3% vs 8.6%, < 0.01). Women were more likely to experience prehospital delays, compared with men. Although reperfusion rates were similar between the groups, men were more likely than women to undergo reperfusion within the first 12 hours of chest pain onset. Among patients undergoing primary PCI, women were more likely to have delayed PCI than were men (80.2% vs 72.9%, = 0.03). Procedural characteristics were similar between groups.
Women in this cohort experienced higher incidence of MACE at 1 year, compared to men, primarily owing to increased mortality. Timeliness of reperfusion appears to be the primary factor impacting differences in outcomes between the 2 groups and may represent an attractive target for quality-improvement initiatives.
ST段抬高型心肌梗死（STEMI）后的预后存在性别差异。评估印度患者STEMI中性别差异的研究报告了相互矛盾的结果。
使用一项前瞻性多中心登记研究，纳入2013年6月至2017年3月期间在印度喀拉拉邦有能力进行经皮冠状动脉介入治疗（PCI）的医院就诊的连续性STEMI患者，以评估1年预后。主要终点是主要不良心脏事件（MACE）的复合终点，包括死亡、中风、非致命性心肌梗死和因心力衰竭再次住院。比较了两个基于性别的倾向评分匹配组的预后。
我们纳入了3194例患者（19.4%为女性）。患有STEMI的女性年龄更大，有更多传统心血管危险因素，且更有可能被归类为生活贫困。倾向评分匹配后，女性发生MACE的发生率更高（20.9%对14.3%，<0.01），主要是由于1年死亡率增加（14.3%对8.6%，<0.01）。与男性相比，女性更有可能经历院前延误。尽管两组之间的再灌注率相似，但男性比女性更有可能在胸痛发作的前12小时内接受再灌注。在接受直接PCI的患者中，女性比男性更有可能延迟PCI（80.2%对72.9%，=0.03）。两组之间的手术特征相似。
与男性相比，该队列中的女性在1年时发生MACE的发生率更高，主要是由于死亡率增加。再灌注的及时性似乎是影响两组预后差异的主要因素，可能是质量改进措施的一个有吸引力的目标。
