Motovska Zuzana, Hlinomaz Ota, Aschermann Michael, Jarkovsky Jiri, Želízko Michael, Kala Petr, Groch Ladislav, Svoboda Michal, Hromadka Milan, Widimsky Petr
Cardiocentre, Third Faculty of Medicine, Charles University and University Hospital Kralovske Vinohrady, Prague, Czechia.
Department of Cardioangiology, International Clinical Research Center, St. Anne's University Hospital Brno, Brno, Czechia.
Front Cardiovasc Med. 2023 Jan 4;9:953567. doi: 10.3389/fcvm.2022.953567. eCollection 2022.
Sex- and gender-associated differences determine the disease response to treatment.
The study aimed to explore the hypothesis that progress in the management of STE-myocardial infarction (STEMI) overcomes the worse outcome in women.
We performed an analysis of three randomized trials enrolling patients treated with primary PCI more than 10 years apart. PRAGUE-1,-2 validated the preference of transport for primary PCI over on-site fibrinolysis. PRAGUE-18 enrollment was ongoing at the time of the functional network of 24/7PCI centers, and the intervention was supported by intensive antiplatelets. The proportion of patients with an initial Killip ≥ 3 was substantially higher in the more recent study (0.6 vs. 6.7%, = 0.004). Median time from symptom onset to the door of the PCI center shortened from 3.8 to 3.0 h, < 0.001. The proportion of women having total ischemic time ≤3 h was higher in the PRAGUE-18 (OR [95% C.I.] 2.65 [2.03-3.47]). However, the percentage of patients with time-to-reperfusion >6 h was still significant (22.3 vs. 27.2% in PRAGUE-18). There was an increase in probability for an initial TIMI flow >0 in the later study (1.49 [1.0-2.23]), and also for an optimal procedural result (4.24 [2.12-8.49], < 0.001). The risk of 30-day mortality decreased by 61% (0.39 [0.17-0.91], = 0.029).
The prognosis of women with MI treated with primary PCI improved substantially with 24/7 regional availability of mechanical reperfusion, performance-enhancing technical progress, and intensive adjuvant antithrombotic therapy. A major modifiable hindrance to achieving this benefit in a broad population of women is the timely diagnosis by health professional services.
性别相关差异决定疾病对治疗的反应。
本研究旨在探讨以下假设，即ST段抬高型心肌梗死（STEMI）管理方面的进展可克服女性患者较差的预后。
我们对三项随机试验进行了分析，这些试验纳入的患者接受直接经皮冠状动脉介入治疗（PCI）的时间相隔超过10年。PRAGUE - 1、- 2验证了直接PCI转运优于现场溶栓的选择。在24/7 PCI中心功能网络建立时，PRAGUE - 18正在进行入组，且干预措施得到强化抗血小板治疗的支持。在最近的研究中，初始Killip≥3级的患者比例显著更高（0.6%对6.7%，P = 0.004）。从症状发作到PCI中心大门的中位时间从3.8小时缩短至3.0小时，P < 0.001。PRAGUE - 18中总缺血时间≤3小时的女性比例更高（比值比[95%置信区间] 2.65 [2.03 - 3.47]）。然而，再灌注时间>6小时的患者百分比仍然显著（PRAGUE - 18中为22.3%对27.2%）。在后期研究中，初始心肌梗死溶栓治疗（TIMI）血流>0级的概率增加（1.49 [1.0 - 2.23]），达到最佳手术结果的概率也增加（4.24 [2.12 - 8.49]，P < 0.001）。30天死亡率风险降低了61%（0.39 [0.17 - 0.91]，P = 0.029）。
通过24/7区域机械再灌注的可及性、性能提升的技术进步以及强化辅助抗栓治疗，接受直接PCI治疗的女性心肌梗死患者的预后有显著改善。在广大女性群体中实现这一益处的一个主要可改变障碍是卫生专业服务机构的及时诊断。
