Cenko Edina, Yoon Jinsung, Bergami Maria, Gale Chris P, Vasiljevic Zorana, Vavlukis Marija, Kedev Sasko, Miličić Davor, Dorobantu Maria, Badimon Lina, Manfrini Olivia, Bugiardini Raffaele
Laboratory of Epidemiological and Clinical Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Bologna, Italy.
Google Cloud AI, Sunnyvale, CA, USA.
Eur Heart J Qual Care Clin Outcomes. 2024 May 7. doi: 10.1093/ehjqcco/qcae035.
Existing data on female sex and excess cardiovascular mortality after myocardial infarction (MI) mostly come from high-income countries (HICs). This study aimed to investigate how sex disparities in treatments and outcomes vary across countries with different income levels.
Data from the ISACS-Archives registry included 22 087 MI patients from 6 HICs and 6 middle-income countries (MICs). MI data were disaggregated by clinical presentation: ST-segment elevation myocardial infarction (STEMI) and non-ST-segment elevation myocardial infarction (NSTEMI). The primary outcome was 30-day mortality.
Among STEMI patients, women in MICs had nearly double the 30-day mortality rate of men (12.4% versus 5.8%; adjusted risk ratio [RR] 2.30, 95% CI 1.98-2.68). This difference was less pronounced in HICs (6.8% versus 5.1%; RR 1.36, 95% CI 1.05-1.75). Despite more frequent treatments and timely revascularization in MICs, sex-based mortality differences persisted even after revascularization (8.0% versus 4.1%; RR 2.05, 95% CI, 1.68-2.50 in MICs and 5.6% versus 2.6%; RR 2.17, 95% CI 1.48-3.18) in HICs. Additionally, women from MICs had higher diabetes rates compared to HICs (31.8% versus 25.1%, standardized difference = 0.15). NSTEMI outcomes were relatively similar between sexes and income groups.
Sex disparities in mortality rates following STEMI are more pronounced in MICs compared to HICs. These disparities cannot be solely attributed to sex-related inequities in revascularization. Variations in mortality may also be influenced by sex differences in socioeconomic factors and baseline comorbidities.
关于女性性别与心肌梗死（MI）后心血管死亡率过高的现有数据大多来自高收入国家（HICs）。本研究旨在调查不同收入水平国家在治疗和结局方面的性别差异如何变化。
ISACS - Archives注册中心的数据包括来自6个高收入国家和6个中等收入国家（MICs）的22087例心肌梗死患者。心肌梗死数据按临床表现分类：ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI）。主要结局是30天死亡率。
在STEMI患者中，中等收入国家女性的30天死亡率几乎是男性的两倍（12.4%对5.8%；调整风险比[RR]2.30，95%可信区间[CI]1.98 - 2.68）。在高收入国家，这种差异不太明显（6.8%对5.1%；RR 1.36，95%CI 1.05 - 1.75）。尽管中等收入国家的治疗更频繁且血管再通更及时，但即使在血管再通后，基于性别的死亡率差异仍然存在（中等收入国家为8.0%对4.1%；RR 2.05，95%CI 1.68 - 2.50，高收入国家为5.6%对2.6%；RR 2.17，95%CI 1.48 - 3.18）。此外，与高收入国家相比，中等收入国家的女性糖尿病患病率更高（31.8%对25.1%，标准化差异 = 0.15）。NSTEMI的结局在性别和收入组之间相对相似。
与高收入国家相比，中等收入国家STEMI后死亡率的性别差异更为明显。这些差异不能仅仅归因于血管再通方面与性别相关的不平等。死亡率的差异也可能受到社会经济因素和基线合并症中性别差异的影响。
