ST段抬高型心肌梗死患者在特征、治疗及院内结局方面的性别差异：来自河南ST段抬高型心肌梗死注册研究的见解

Sex Disparity in Characteristics, Management, and In-Hospital Outcomes of Patients with ST-Segment Elevated Myocardial Infarction: Insights from Henan STEMI Registry.

作者信息

Wang Shan, Zhang You, Cheng Qianqian, Qi Datun, Wang Xianpei, Zhu Zhongyu, Li Muwei, Zhang Junhui, Hu Dayi, Gao Chuanyu, Henan Stemi Registry Study Group On Behalf Of

机构信息

Department of Cardiology, Central China Fuwai Hospital of Zhengzhou University, Henan Provincial People's Hospital Heart Center, Zhengzhou, China.

Henan Institute of Cardiovascular Epidemiology, Zhengzhou, China.

出版信息

Cardiol Res Pract. 2022 Sep 5;2022:2835485. doi: 10.1155/2022/2835485. eCollection 2022.

DOI:10.1155/2022/2835485

PMID:36105435

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9467791/

Abstract

BACKGROUND

Women hospitalized with ST-elevation myocardial infarction (STEMI) experience higher risk of early mortality than men. We aimed to investigate the potential impact of risk factors, clinical characteristics, and management among gender-related risk differences.

METHOD

We analyzed 5063 STEMI patients prospectively enrolled from 66 hospitals during 2016-2018 and compared sex differences in mortality, death, or treatment withdrawal and main adverse cardiovascular and cerebrovascular events (MACCE) using the generalized linear mixed model, following sequential adjustment for covariates.

RESULTS

Women were older and had a higher prevalence of hypertension (53.3% vs. 41.1%, < 0.001) and diabetes (24.5% vs. 15.2%, < 0.001). Eligible women were less likely to receive reperfusion therapy (56.1% vs. 62.4%, < 0.001); the onset to first medical contact (FMC) (255 vs. 190 minutes, < 0.001), onset to fibrinolysis (218 vs. 185 minutes, < 0.001), and onset to percutaneous coronary intervention (PCI) (307 vs. 243 minutes, < 0.001) were significantly delayed in women. The incidence of in-hospital death (6.8% vs. 3.0%, < 0.001), death or treatment withdrawal (14.5% vs. 5.6%, < 0.001), and MACCE (18.5% vs. 9.4%, < 0.001) were notably higher. The gender disparities persist in death (OR: 1.61, 95% CI: 1.12-2.33), death or treatment withdrawal (OR: 1.68, 95% CI: 1.26-2.24), and MACCE (OR: 1.37, 95% CI: 1.08-1.74) after adjustment for covariates. Among possible explanatory factors, age (-58.46%, -59.04%, -62.20%) and cardiovascular risk factors (-40.77%, -39.36%, -41.73%) accounted for most of the gender-associated risk differences.

CONCLUSIONS

Women experienced worse in-hospital outcomes, and age and cardiovascular risk factors were major factors influencing sex-related differences. The sex disparity stressed the awareness and importance of quality improvement efforts against female patients in clinical practice.

摘要

背景

因ST段抬高型心肌梗死（STEMI）住院的女性患者早期死亡风险高于男性。我们旨在研究风险因素、临床特征及治疗管理方面与性别相关的风险差异的潜在影响。

方法

我们分析了2016年至2018年期间从66家医院前瞻性纳入的5063例STEMI患者，并使用广义线性混合模型比较了死亡率、死亡或治疗中断以及主要不良心血管和脑血管事件（MACCE）方面的性别差异，同时对协变量进行了顺序调整。

结果

女性患者年龄更大，高血压患病率更高（53.3%对41.1%，P<0.001），糖尿病患病率更高（24.5%对15.2%，P<0.001）。符合条件的女性接受再灌注治疗的可能性较小（56.1%对62.4%，P<0.001）；女性从发病到首次医疗接触（FMC）的时间（255分钟对190分钟，P<0.001）、从发病到溶栓的时间（218分钟对185分钟，P<0.001）以及从发病到经皮冠状动脉介入治疗（PCI）的时间（307分钟对243分钟，P<0.001）均显著延迟。住院死亡率（6.8%对3.0%，P<0.001）、死亡或治疗中断率（14.5%对5.6%，P<0.001）以及MACCE发生率（18.5%对9.4%，P<0.0每01）在女性中明显更高。在对协变量进行调整后，性别差异在死亡（比值比：1.61，95%置信区间：1.12 - 2.33）、死亡或治疗中断（比值比：1.68，95%置信区间：1.26 - 2.24）以及MACCE（比值比：1.37，95%置信区间：1.08 - 1.74）方面仍然存在。在可能的解释因素中，年龄（-58.46%，-5每次04%，-62.20%）和心血管危险因素（-40.77%，-39.36%，-41.73%）占了大部分与性别相关的风险差异。