Cook Selma T, Allemann Laure, Cook Malica, Arroyo Diego A, Pittet Thais, Meier Pascal, Togni Mario, Brahim-Mathiron Amel, Puricel Serban, Cook Stéphane
Cardiology, University Hospital Fribourg, Fribourg, Switzerland.
Cardiology, University Hospital Fribourg, Fribourg, Switzerland
Open Heart. 2025 Jan 4;12(1):e002831. doi: 10.1136/openhrt-2024-002831.
The impact of sex on coronary artery disease prognosis is debated. It has been postulated that women receive less prompt treatment compared with men, potentially adversely affecting their prognosis by significantly increasing the risk of morbidity and mortality. We aim to investigate the influence of sex on the timing and clinical outcomes of ST-segment elevation myocardial infarction (STEMI) patients using a controlled Swiss registry.
Based on the Fribourg STEMI Fast Track Registry, 1177 patients (288 women, 889 men) with >12 months clinical follow-up were selected. Women had longer first medical contact to reperfusion times (1.31 (1.14-2.00) vs 1.27 (1.09-1.54) hours, p=0.035) but similar total ischaemic times (3.04 (2.15-4.50) vs 2.56 (2.07-4.38) hours, p=0.064). Men had higher rates of diabetes, smoking and dyslipidaemia, while women had higher hypertension and renal insufficiency rates. No significant sex differences in clinical outcomes were observed at 1-year and 5-year follow-ups.
The study found sex differences in patient profiles and minor treatment delays for women, which did not significantly affect outcomes. Efforts to improve sex equity in STEMI care are effective, as no significant outcome differences were observed. Disparities are more related to patient characteristics than sex.
Despite slight delays and different risk profiles for women with STEMI, clinical outcomes are similar between sexes. Ongoing efforts are needed to ensure sex equity in acute coronary syndrome management.
NCT04185285.
性别对冠状动脉疾病预后的影响存在争议。据推测，与男性相比，女性接受的治疗不够及时，这可能会显著增加发病和死亡风险，从而对其预后产生不利影响。我们旨在利用瑞士一个对照登记系统，研究性别对ST段抬高型心肌梗死（STEMI）患者治疗时机和临床结局的影响。
基于弗里堡STEMI快速通道登记系统，选取了1177例有超过12个月临床随访的患者（288例女性，889例男性）。女性从首次医疗接触到再灌注的时间更长（1.31（1.14 - 2.00）小时 vs 1.27（1.09 - 1.54）小时，p = 0.035），但总的缺血时间相似（3.04（2.15 - 4.50）小时 vs 2.56（2.07 - 4.38）小时，p = 0.064）。男性患糖尿病、吸烟和血脂异常的比例较高，而女性高血压和肾功能不全的比例较高。在1年和5年随访中，未观察到临床结局存在显著的性别差异。
该研究发现患者特征存在性别差异，女性在治疗上有轻微延迟，但这并未显著影响结局。改善STEMI治疗中性别平等的努力是有效的，因为未观察到显著的结局差异。差异更多地与患者特征而非性别相关。
尽管STEMI女性患者存在轻微延迟和不同的风险特征，但两性的临床结局相似。需要持续努力以确保急性冠状动脉综合征管理中的性别平等。
NCT04185285。
