Ardissino Maddalena, Nelson Adam J, Maglietta Giuseppe, Malagoli Tagliazucchi Guidantonio, Disisto Caterina, Celli Patrizia, Ferrario Maurizio, Canosi Umberto, Cernetti Carlo, Negri Francesco, Merlini Piera Angelica, Tubaro Marco, Berzuini Carlo, Manzalini Chiara, Ignone Gianfranco, Campana Carlo, Moschini Luigi, Ponte Elisabetta, Pozzi Roberto, Fetiveau Raffaela, Buratti Silvia, Paraboschi Elvezia Maria, Asselta Rosanna, Botti Andrea, Tuttolomondo Domenico, Barocelli Federico, Bricoli Serena, Biagi Andrea, Bonura Rosario, Moccetti Tiziano, Crocamo Antonio, Benatti Giorgio, Paoli Giorgia, Solinas Emilia, Notarangelo Maria Francesca, Moscarella Elisabetta, Calabrò Paolo, Duga Stefano, Magnani Giulia, Ardissino Diego
Imperial College London, London, United Kingdom.
Duke Clinical Research Institute, Durham, NC, United States.
Front Cardiovasc Med. 2022 Jul 4;9:863811. doi: 10.3389/fcvm.2022.863811. eCollection 2022.
There is growing awareness of sex-related differences in cardiovascular risk profiles, but less is known about whether these extend to pre-menopausal females experiencing an early-onset myocardial infarction (MI), who may benefit from the protective effects of estrogen exposure.
A nationwide study involving 125 Italian Coronary Care Units recruited 2,000 patients between 1998 and 2002 hospitalized for a type I myocardial infarction before the age of 45 years (male, = 1,778 (88.9%). Patients were followed up for a median of 19.9 years (IQR 18.1-22.6). The primary composite endpoint was the occurrence of cardiovascular death, non-fatal myocardial re-infarction or non-fatal stroke, and the secondary endpoint of hospitalization for revascularisation by means of a percutaneous coronary intervention (PCI) or coronary artery bypass surgery (CABG).
ST-elevation MI was the most frequent presentation among both men and women (85.1 vs. 87.4%, p = ns), but the men had a greater baseline coronary atherosclerotic burden (median Duke Coronary Artery Disease Index: 48 vs. 23; median Syntax score 9 vs. 7; both < 0.001). The primary composite endpoint occurred less frequently among women (25.7% vs. 37.0%; adjusted hazard ratio: 0.69, 95% CI 0.52-0.91; = 0.01) despite being less likely to receive treatment with most secondary prevention medications during follow up.
There are significant sex-related differences in baseline risk factors and outcomes among patients with early-onset MI: women present with a lower atherosclerotic disease burden and, although they are less frequently prescribed secondary prevention measures, experience better long-term outcomes.
4272/98 Ospedale Niguarda, Ca' Granda 03/09/1998.
人们越来越意识到心血管风险状况存在性别差异，但对于这些差异是否延伸至患有早发性心肌梗死（MI）的绝经前女性，却知之甚少，而这些女性可能会从雌激素暴露的保护作用中获益。
一项涉及125个意大利冠心病监护病房的全国性研究，在1998年至2002年间招募了2000名45岁之前因I型心肌梗死住院的患者（男性1778例[88.9%]）。对患者进行了中位数为19.9年的随访（四分位间距18.1 - 22.6年）。主要复合终点是心血管死亡、非致命性心肌再梗死或非致命性中风的发生，次要终点是通过经皮冠状动脉介入治疗（PCI）或冠状动脉旁路移植术（CABG）进行血管重建的住院治疗。
ST段抬高型心肌梗死在男性和女性中都是最常见的表现形式（85.1%对87.4%，p = 无显著差异），但男性的基线冠状动脉粥样硬化负担更重（中位杜克冠状动脉疾病指数：48对23；中位Syntax评分9对7；均p < 0.001）。尽管在随访期间女性接受大多数二级预防药物治疗的可能性较小，但主要复合终点在女性中的发生频率较低（25.7%对37.0%；调整后的风险比：0.69，95%置信区间0.52 - 0.91；p = 0.01）。
早发性心肌梗死患者在基线风险因素和预后方面存在显著的性别差异：女性的动脉粥样硬化疾病负担较低，并且尽管她们接受二级预防措施的频率较低，但长期预后较好。
4272/98 尼瓜尔达医院，卡格兰达 于1998年9月3日注册
