Burgess Sonya, Juergens Craig P, Yang Wesley, Shugman Ibrahim M, Idris Hanan, Nguyen Tuan, McLean Alison, Zaman Sarah, Thomas Liza, Robledo Kristy P, Mussap Christian, Lo Sidney, French John
Cardiology Department, Ingham Institute at Liverpool Hospital Sydney, Australia.
Department of Medicine, University of New South Wales Sydney, Australia.
Eur Cardiol. 2023 Apr 4;18:e10. doi: 10.15420/ecr.2022.39. eCollection 2023.
To investigate the extent to which multivessel disease, incomplete revascularisation and prescribing differences contribute to sex-based outcome disparities in patients with ST-elevation MI (STEMI) and establish whether differences in cardiac death and MI (CDMI) rates persist at long-term follow-up. This observational study evaluates sex-based outcome differences (median follow-up 3.6 years; IQR [2.4-5.4]) in a consecutive cohort of patients (n=2,083) presenting with STEMI undergoing percutaneous coronary intervention). Of the studied patients 20.3% (423/2,083) were women and 38.3% (810/2,083) had multivessel disease (MVD). Incomplete revascularisation was common. The median residual SYNTAX score (rSS) was 5.0 (IQR [0-9]) in women and 5.0 (IQR [1-11]) in men (p=0.369), and in patients with MVD it was 9 (IQR [6-17]) in women and 10 (IQR [6-15]) in men (p=0.838). The primary endpoint CDMI occurred in 20.3% of women (86/423) and in 13.2% of men (219/1,660) (p=0.028). Differences persisted following multivariable risk adjustment: female sex was independently associated with CDMI (aHR 1.33; IQR [1.02-1.74]). Women with MVD had CDMI more often than all other groups (p<0.001 for all). Significant sex-based prescribing differences were evident: women were less likely to receive guideline-recommended potent P2Y12 inhibitors than men (31% versus 43%; p=0.012), and differences were particularly evident in patients with MVD (25% in women versus 45% in men, p=0.011). : Sex-based differences in STEMI patient outcome persist at long-term follow-up. Poor outcomes were disproportionately found in women with MVD and those with rSS>8. Observed differences in P2Y prescribing practices may contribute to poor outcomes for women with MVD and incomplete revascularisation.
为了研究多支血管病变、血运重建不完全及处方差异在ST段抬高型心肌梗死（STEMI）患者基于性别的预后差异中所起的作用程度，并确定心脏死亡和心肌梗死（CDMI）发生率的差异在长期随访中是否依然存在。这项观察性研究评估了连续队列中（n = 2083例）接受经皮冠状动脉介入治疗的STEMI患者基于性别的预后差异（中位随访3.6年；四分位间距[2.4 - 5.4]）。在研究患者中，20.3%（423/2083）为女性，38.3%（810/2083）患有多支血管病变（MVD）。血运重建不完全情况很常见。女性的中位残余SYNTAX评分（rSS）为5.0（四分位间距[0 - 9]），男性为5.0（四分位间距[1 - 11]）（p = 0.369），在患有MVD的患者中，女性为9（四分位间距[6 - 17]），男性为10（四分位间距[6 - 15]）（p = 0.838）。主要终点CDMI在20.3%的女性（86/423）和13.2%的男性（219/1660）中出现（p = 0.028）。多变量风险调整后差异依然存在：女性性别与CDMI独立相关（调整后风险比1.33；四分位间距[1.02 - 1.74]）。患有MVD的女性比所有其他组更常发生CDMI（所有比较p<0.001）。基于性别的显著处方差异很明显：女性比男性更不太可能接受指南推荐的强效P2Y12抑制剂（31%对43%；p = 0.012），且差异在患有MVD的患者中尤为明显（女性为25%，男性为45%，p = 0.011）。STEMI患者预后的基于性别的差异在长期随访中依然存在。不良预后在患有MVD和rSS>8的女性中不成比例地多见。观察到的P2Y处方实践差异可能导致患有MVD和血运重建不完全的女性预后不良。
