Department of Internal Medicine, the National University Hospital of Iceland, Reykjavik, Iceland.
Department of Anesthesia and Intensive Care, the National University Hospital of Iceland, Reykjavik, Iceland.
Scand Cardiovasc J. 2022 Dec;56(1):114-120. doi: 10.1080/14017431.2022.2075561.
. To evaluate the impact of sex on treatment and survival after acute myocardial infarction (AMI) in Iceland. . A retrospective, nationwide cohort study of patients with STEMI (2008-2018) and NSTEMI (2013-2018) and obstructive coronary artery disease. Patient and procedural information were obtained from a registry and electronic health records. Survival was estimated with Kaplan-Meier method and Cox regression analysis used to identify risk factors for long-term mortality. Excess mortality from the AMI episode was estimated by comparing the survival with age- and sex-matched population in Iceland at 30-day interval. . A total of 1345 STEMI-patients (24% women) and 1249 NSTEMI-patients (24% women) were evaluated. Women with STEMI (mean age: 71 ± 11 67 ± 12) and NSTEMI (mean age: 69 ± 13 62 ± 12) were older and less likely to have previous cardiovascular disease. There was neither sex difference in the extent of coronary artery disease nor treatment. Although crude one-year post-STEMI survival was lower for women (88.7% . 93.4%, = .006), female sex was not an independent risk factor after adjusting for age and co-morbidities after STEMI and was protective for NSTEMI (HR 0.67, 95% CI: 0.46-0.97). There was excess 30-day mortality in both STEMI and NSTEMI for women compared with sex-, age- and inclusion year-matched Icelandic population, but thereafter the mortality rate was similar. . Women and men with AMI in Iceland receive comparable treatment including revascularization and long-term survival appears similar. Prognosis after NSTEMI is better in women, whereas higher early mortality after STEMI may be caused by delays in presentation and diagnosis.
. 评估在冰岛急性心肌梗死（AMI）后治疗和生存中性别差异。. 这是一项回顾性、全国性队列研究，纳入了 2008 年至 2018 年 ST 段抬高型心肌梗死（STEMI）和 2013 年至 2018 年非 ST 段抬高型心肌梗死（NSTEMI）及阻塞性冠状动脉疾病患者。患者和治疗信息来自登记和电子健康记录。采用 Kaplan-Meier 法估计生存率，并采用 Cox 回归分析确定长期死亡率的危险因素。通过与冰岛 30 天间隔的年龄和性别匹配人群的生存率比较，估计 AMI 发作的超额死亡率。. 共评估了 1345 例 STEMI 患者（24%为女性）和 1249 例 NSTEMI 患者（24%为女性）。STEMI（平均年龄：71±11 67±12）和 NSTEMI（平均年龄：69±13 62±12）女性年龄更大，且既往心血管疾病发生率更低。STEMI 和 NSTEMI 患者的冠状动脉疾病严重程度和治疗均无性别差异。尽管女性 STEMI 患者的 1 年粗生存率较低（88.7%. 93.4%，=.006），但在 STEMI 后调整年龄和合并症后，女性性别不是独立的危险因素，且对 NSTEMI 具有保护作用（HR 0.67，95%CI：0.46-0.97）。与年龄和性别匹配的冰岛人群相比，STEMI 和 NSTEMI 女性患者的 30 天死亡率均过高，但此后死亡率相似。. 在冰岛，AMI 女性和男性患者接受的治疗相似，包括血运重建，长期生存率也相似。女性 NSTEMI 预后较好，而 STEMI 早期死亡率较高可能是由于就诊和诊断延迟所致。
