Department of Medicine, Lincoln Medical Center, New York, NY, USA.
Department of Medicine, Cebu Institute of Medicine, Cebu, Philippines.
Expert Rev Cardiovasc Ther. 2024 Jan-Mar;22(1-3):111-120. doi: 10.1080/14779072.2024.2311707. Epub 2024 Jan 31.
Mechanical complications (MC) are rare but significant sequelae of acute myocardial infarction (AMI). Current data on sex differences in AMI with MC is limited.
We queried the National Inpatient Sample database to identify adult patients with the primary diagnosis of AMI and MC. The main outcome of interest was sex difference in-hospital mortality. Secondary outcomes were sex differences in the incidence of acute kidney injury (AKI), major bleeding, use of inotropes, permanent pacemaker implantation (PPMI), performance of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), surgery (VSD repair and MV surgery), pericardiocentesis, use of mechanical circulatory support (MCS), ischemic stroke, and mechanical ventilation.
Among AMI-MC cohort, in-hospital mortality was higher among females compared to males (41.24% vs 28.13%: aOR 1.39. 95% CI 1.079-1.798; = 0.01). Among those who had VSD, females also had higher in-hospital mortality compared to males (56.7% vs 43.1%: aOR 1.74, 95% CI 1.12-2.69; = 0.01). Females were less likely to receive CABG compared to males (12.03% vs 20%: aOR 0.49 95% CI 0.345-0.690; < 0.001).
Despite the decreasing trend in AMI admission, females had higher risk of MC and associated mortality. Significant sex disparities still exist in AMI treatment.
机械并发症（MC）是急性心肌梗死（AMI）罕见但严重的后遗症。目前关于 AMI 伴 MC 的性别差异的数据有限。
我们在国家住院患者样本数据库中查询了患有 AMI 和 MC 主要诊断的成年患者。主要观察结果是住院死亡率的性别差异。次要观察结果是急性肾损伤（AKI）、大出血、使用正性肌力药、永久性起搏器植入（PPMI）、经皮冠状动脉介入治疗（PCI）、冠状动脉旁路移植术（CABG）、手术（室间隔缺损修复和 MV 手术）、心包穿刺术、使用机械循环支持（MCS）、缺血性脑卒中、机械通气的性别差异。
在 AMI-MC 队列中，女性的住院死亡率高于男性（41.24% vs 28.13%：aOR 1.39，95%CI 1.079-1.798； = 0.01）。在接受 VSD 治疗的患者中，女性的住院死亡率也高于男性（56.7% vs 43.1%：aOR 1.74，95%CI 1.12-2.69； = 0.01）。与男性相比，女性接受 CABG 的可能性较小（12.03% vs 20%：aOR 0.49，95%CI 0.345-0.690； < 0.001）。
尽管 AMI 入院率呈下降趋势，但女性发生 MC 及相关死亡率的风险更高。AMI 治疗中仍然存在显著的性别差异。
