Department of Medicine, Lincoln Medical Center, New York, New York, USA.
Cebu Institute of Medicine, Cebu, Philippines.
Cardiorenal Med. 2024;14(1):473-482. doi: 10.1159/000540783. Epub 2024 Aug 12.
There is limited evidence as to the effect of sex on the outcomes of patients admitted for ST-elevation myocardial infarction (STEMI) who have a concomitant diagnosis of chronic kidney disease (CKD) and end-stage renal disease (ESRD). We aimed to determine if there are differences in the outcomes between males and females in these patient populations.
Data were obtained from the National Inpatient Sample database and patients were selected using the International Classification of Diseases, Ninth and Tenth Revision (ICD-9 and -10) codes. Hospitalizations for patients with CKD who had STEMI from 2012 to 2020 were included. The primary outcome of interest was in-hospital mortality. Secondary outcomes evaluated included ischemic stroke, major bleeding complications, pressor requirement, permanent pacemaker implantation, percutaneous coronary intervention, coronary artery bypass grafting, surgery, pericardiocentesis, mechanical circulatory support, and mechanical ventilation.
A total of 1,283,255 STEMI patients without CKD, 158,715 STEMI patients with CKD, and 22,690 STEMI patients with ESRD were identified and analyzed. Among patients with STEMI and CKD, females demonstrated higher in-hospital mortality compared to male counterparts (16.7% vs. 12.7%, aOR = 1.13, 95% CI: 1.05-1.21, p < 0.01). While there was no sex difference in the in-hospital mortality among STEMI patients with ESRD, female patients in this group were less likely to receive coronary artery bypass grafting and mechanical circulatory support.
Increased in-hospital mortality rates were shown for females admitted for STEMI with CKD. Among patients with ESRD who had STEMI, females were less likely to receive coronary artery bypass grafting and mechanical circulatory support. Further research needs to be conducted to better explain this said difference in outcomes.
关于伴有慢性肾脏病（CKD）和终末期肾病（ESRD）的 ST 段抬高型心肌梗死（STEMI）患者的性别对其结局的影响，证据有限。我们旨在确定在这些患者人群中，男性和女性的结局是否存在差异。
数据来自国家住院患者样本数据库，并使用国际疾病分类第 9 和第 10 版（ICD-9 和 -10）代码选择患者。纳入 2012 年至 2020 年 CKD 合并 STEMI 住院患者。主要观察指标为院内死亡率。评估的次要结局包括缺血性脑卒中、大出血并发症、升压药需求、永久性起搏器植入、经皮冠状动脉介入治疗、冠状动脉旁路移植术、手术、心包穿刺术、机械循环支持和机械通气。
共确定并分析了 1283255 例无 CKD 的 STEMI 患者、158715 例 CKD 的 STEMI 患者和 22690 例 ESRD 的 STEMI 患者。在伴有 CKD 的 STEMI 患者中，女性的院内死亡率高于男性（16.7%比 12.7%，aOR=1.13，95%CI：1.05-1.21，p <0.01）。而在伴有 ESRD 的 STEMI 患者中，性别与院内死亡率之间无差异，但女性患者接受冠状动脉旁路移植术和机械循环支持的可能性较小。
伴有 CKD 的 STEMI 女性患者的院内死亡率较高。在伴有 ESRD 的 STEMI 患者中，女性患者接受冠状动脉旁路移植术和机械循环支持的可能性较小。需要进一步研究以更好地解释这种结局差异。
