Huded Chetan P, Kumar Anirudh, Kassis Nicholas, Johnson Michael J, Kravitz Kathleen, Brown Abigail, Shanahan Marguerite, Trentanelli Karen, Reed Grant W, Menon Venu, Krishnaswamy Amar, Ellis Stephen G, Kralovic Damon M, Meldon Stephen W, Kapadia Samir R, Khot Umesh N
Saint Luke's Mid America Heart Institute, Kansas City, MO, USA.
Cleveland Clinic Heart, Vascular, & Thoracic Institute, Cleveland, OH, USA.
Eur Heart J Open. 2021 Aug 20;1(3):oeab011. doi: 10.1093/ehjopen/oeab011. eCollection 2021 Nov.
To determine whether a comprehensive ST-elevation myocardial infarction (STEMI) protocol is associated with reduced sex disparities over 5 years.
This was an observational cohort study of 1833 consecutive STEMI patients treated with percutaneous coronary intervention (PCI) before (1 January 2011-14 July 2014, control group) and after (15 July 2014-15 July 2019, protocol group) implementation of a protocol for early guideline-directed medical therapy (GDMT), rapid door to balloon time (D2BT), and use of trans-radial PCI. In the control group, females had less GDMT (77.1% vs. 68.1%, = 0.03), similarly low trans-radial PCI (19.0% vs. 17.6%, = 0.73), and longer D2BT [104 min (79, 133) vs. 112 min (85, 147), = 0.02] corresponding to higher in-hospital mortality [4.5% vs. 10.3%, odds ratio (OR) 2.44 (1.34-4.46), = 0.004], major adverse cardiac and cerebrovascular events [MACCE, 9.8% vs. 16.3%, OR 1.79 (1.14-2.84), = 0.01], and net adverse clinical events [NACE, 16.1% vs. 28.3%, OR 2.06 (1.42-2.99), < 0.001]. In the protocol group, no significant sex differences were observed in GDMT (87.2% vs. 86.4%, = 0.81) or D2BT [85 min (64-106) vs. 89 min (65-111), = 0.06], but trans-radial PCI was used less in females (77.6% vs. 71.2%, = 0.03). In-hospital mortality [2.5% vs. 4.4%, OR 1.78 (0.91-3.51), = 0.09] and MACCE [9.0% vs. 11.1%, OR 1.27 (0.83-1.92), = 0.26] were similar between sexes, but higher NACE in females approached significance [14.8% vs. 19.4%, OR 1.38 (0.99-1.92), = 0.05] due to higher bleeding risk [7.2% vs. 11.1%, OR 1.60 (1.04-2.46), = 0.03].
A comprehensive STEMI protocol was associated with sustained reductions for in-hospital ischaemic outcomes over 5 years, but higher bleeding rates in females persisted.
确定一项全面的ST段抬高型心肌梗死（STEMI）方案在5年时间里是否与缩小性别差异相关。
这是一项观察性队列研究，纳入了1833例接受经皮冠状动脉介入治疗（PCI）的连续性STEMI患者，分为实施早期指南导向药物治疗（GDMT）、快速门球时间（D2BT）及使用桡动脉PCI方案之前（2011年1月1日至2014年7月14日，对照组）和之后（2014年7月15日至2019年7月15日，方案组）。在对照组中，女性接受GDMT的比例较低（77.1%对68.1%，P = 0.03），桡动脉PCI使用率同样较低（19.0%对17.6%，P = 0.73），D2BT更长[104分钟（79，133）对112分钟（85，147），P = 0.02]，这对应着更高的院内死亡率[4.5%对10.3%，比值比（OR）2.44（1.34 - 4.46），P = 0.004]、主要不良心脑血管事件[MACCE，9.8%对16.3%，OR 1.79（1.14 - 2.84），P = 0.01]以及净不良临床事件[NACE，16.1%对28.3%，OR 2.06（1.42 - 2.99），P < 0.001]。在方案组中，GDMT（87.2%对86.4%，P = 0.81）或D2BT[85分钟（64 - 106）对89分钟（65 - 111），P = 0.06]未观察到显著的性别差异，但女性桡动脉PCI使用率较低（77.6%对71.2%，P = 0.03）。两性之间院内死亡率[2.5%对4.4%，OR 1.78（0.91 - 3.51），P = 0.09]和MACCE[9.0%对11.1%，OR 1.27（0.83 - 1.92），P = 0.26]相似，但女性较高的NACE接近显著水平[14.8%对19.4%，OR 1.38（0.99 - 1.92），P = 0.05]，原因是出血风险较高[7.2%对1十一.1%，OR 1.60（1.04 - 2.46），P = 0.03]。
一项全面的STEMI方案与5年期间持续降低院内缺血性结局相关，但女性较高的出血率仍然存在。
