Keele Cardiovascular Research Group, School of Medicine, Keele University, Stoke-on-Trent, UK; Department of Cardiology, Royal Stoke University Hospital, Stoke-on-Trent, UK.
Population Health Research Institute, Hamilton, Ontario, Canada; Department of Medicine and Department of Health Research, Evidence, and Impact, McMaster University, Hamilton, Ontario, Canada.
Mayo Clin Proc. 2022 Sep;97(9):1608-1618. doi: 10.1016/j.mayocp.2022.06.011.
To assess the impact of patient's sex on outcomes and management of acute myocardial infarction (AMI) patients presenting with out-of-hospital cardiac arrest (OHCA).
We conducted a population-based retrospective cohort study in AMI patients admitted with OHCA between 2010 and 2017 from the Myocardial Ischaemia National Audit Project (MINAP) registry. We used multivariable logistic regression models to evaluate the role of sex as a predictor of clinical outcomes and treatment strategy.
Of 16,278 patients, women constituted almost one-quarter of the population (n=3710 [22.7%]). Women were older (median age 69 [IQR, 57-79] years vs 63 [IQR, 54-72] years, P<.001), experienced longer call-to-hospital-arrival time (median, 1.2 hours vs 1.1 hours; P=.008), were less likely to present with shockable rhythm (86.8% vs 91.5%, P<.001), and less likely to receive dual antiplatelet therapy (73.8% vs 78.6%, P<.001), beta blockers (64.7% vs 72.3%, P<.001), angiotensin-converting enzyme inhibitors (49.0% vs 55.3%, P<.001), coronary angiography (73.7% vs 83.3%, P<.001), and percutaneous coronary intervention (37.5% vs. 40.7%, p 0.004). After adjusting for patient characteristics and management, women had significantly higher odds of in-hospital death compared with men (odds ratio [OR], 1.3; 95% CI, 1.1 to 1.5) and lower odds of receiving coronary angiography (OR, 0.67; 95% CI, 0.59 to 0.75) and coronary artery bypass graft (OR, 0.28; 95% CI, 0.19 to 0.40).
Women were less likely to survive following OHCA secondary to AMI. Hospital protocols that minimize physician bias and improve women-physician communication are needed to close this gap.
评估患者性别对因院外心脏骤停（OHCA）而就诊的急性心肌梗死（AMI）患者结局和治疗的影响。
我们在 2010 年至 2017 年期间，从心肌缺血国家审计项目（MINAP）登记处对因 OHCA 而入院的 AMI 患者进行了一项基于人群的回顾性队列研究。我们使用多变量逻辑回归模型来评估性别作为临床结局和治疗策略预测因素的作用。
在 16278 例患者中，女性占近四分之一（n=3710[22.7%]）。女性年龄更大（中位数 69[IQR，57-79]岁 vs 63[IQR，54-72]岁，P<.001），呼叫至医院到达时间更长（中位数，1.2 小时 vs 1.1 小时；P=.008），更不可能出现可除颤节律（86.8% vs 91.5%，P<.001），且更不可能接受双联抗血小板治疗（73.8% vs 78.6%，P<.001）、β受体阻滞剂（64.7% vs 72.3%，P<.001）、血管紧张素转换酶抑制剂（49.0% vs 55.3%，P<.001）、冠状动脉造影（73.7% vs 83.3%，P<.001）和经皮冠状动脉介入治疗（37.5% vs. 40.7%，p<.001）。在调整患者特征和治疗后，女性住院死亡的几率明显高于男性（比值比[OR]，1.3；95%CI，1.1 至 1.5），接受冠状动脉造影的几率较低（OR，0.67；95%CI，0.59 至 0.75）和冠状动脉旁路移植术（OR，0.28；95%CI，0.19 至 0.40）的几率也较低。
女性因 OHCA 继发 AMI 后更不可能存活。需要制定医院方案，以最大程度减少医生偏见并改善医患沟通，从而缩小这一差距。
