Sex Differences in Outcomes After STEMI Effect Modification by Treatment Strategy and Age
Sex Differences in Outcomes After STEMI Effect Modification by Treatment Strategy and Age
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DOI：
10.1001/jamainternmed.2018.0514
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发表时间：
2018-05-01
影响因子：
39
通讯作者：
Bugiardini, Raffaele
中科院分区：
文献类型：
--
作者：
Cenko, Edina;Yoon, Jinsung;Bugiardini, Raffaele
重要性既往研究表明，ST段抬高型心肌梗死（STEMI）女性患者的短期死亡率高于男性。然而，目前尚不清楚这些差异是否持续在接受当代直接经皮冠状动脉介入治疗（PCI）的患者中。目的研究STEMI后30天死亡率的风险是否女性高于男性，如果是这样，评估年龄，药物和直接PCI在这种过度风险中的作用。设计，设置和参与者从2010年1月至2016年1月，共有8834名患者因ST段抬高型心肌梗死在41家医院住院并接受药物治疗，参考转型国家急性冠状动脉综合征国际调查数据（ISACS-TC）登记册（NCT 01218776）。暴露人口统计学、基线特征、临床特征，主要结果和指标：使用治疗加权逆概率（IPTW）估计的调整后30天死亡率结果：本研究包括2657名女性，平均（SD）年龄为66.1（11.6）岁，6177名男性，平均（SD）年龄为59.9（11.7）岁。女性30天死亡率明显高于男性（11.6%比6.0%，P <0.001）。如果将分析限制在接受直接PCI的男性和女性，则性别特异性死亡率的差距缩小（7.1% vs 3.3%，P <0.001）。在对合并症和治疗协变量进行多变量调整后，60岁以下女性的早期死亡风险高于同年龄组的男性（OR，1.88; 95%CI，1.04-3.26; P = .02）。在60 - 74岁和75岁以上的亚组中，性别之间的风险无显著差异（OR，1.28; 95%CI，0.88-1.88; P = 0.19和OR，1.17; 95%CI，0.80-1.73; P = 0.40;分别）。在对基线临床协变量进行IPTW调整后，性别、年龄分类和30天死亡率之间的关系相似（OR，1.56 [95% CI，1.05-2.3]; OR，1.49 [95% CI，1.15-1.92];和OR，1.21 [95% CI，0.93-1.57];分别）。结论和相关性即使在调整药物、初次经皮冠状动脉介入治疗和其他共存合并症后，年龄越小，STEMI女性的30天死亡率越高。这种差异在60岁以后下降，在老年妇女中不再观察到。
IMPORTANCE Previous works have shown that women hospitalized with ST-segment elevationmyocardial infarction (STEMI) have higher short-term mortality rates than men. However, it is unclear if these differences persist among patients undergoing contemporary primary percutaneous coronary intervention (PCI).OBJECTIVE To investigate whether the risk of 30-day mortality after STEMI is higher in women than men and, if so, to assess the role of age, medications, and primary PCI in this excess of risk.DESIGN, SETTING, AND PARTICIPANTS From January 2010 to January 2016, a total of 8834 patients were hospitalized and received medical treatment for STEMI in 41 hospitals referring data to the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACS-TC) registry (NCT01218776).EXPOSURES Demographics, baseline characteristics, clinical profile, and pharmacological treatment within 24 hours and primary PCI.MAIN OUTCOMES AND MEASURES Adjusted 30-day mortality rates estimated using inverse probability of treatment weighted (IPTW) logistic regression models.RESULTS There were 2657 women with a mean (SD) age of 66.1 (11.6) years and 6177 men with a mean (SD) age of 59.9 (11.7) years included in the study. Thirty-day mortality was significantly higher for women than for men (11.6% vs 6.0%, P < .001). The gap in sex-specific mortality narrowed if restricting the analysis to men and women undergoing primary PCI (7.1% vs 3.3%, P < .001). After multivariable adjustment for comorbidities and treatment covariates, women under 60 had higher early mortality risk than men of the same age category (OR, 1.88; 95% CI, 1.04-3.26; P = .02). The risk in the subgroups aged 60 to 74 years and over 75 years was not significantly different between sexes (OR, 1.28; 95% CI, 0.88-1.88; P = .19 and OR, 1.17; 95% CI, 0.80-1.73; P = .40; respectively). After IPTWadjustment for baseline clinical covariates, the relationship among sex, age category, and 30-day mortality was similar (OR, 1.56 [95% CI, 1.05-2.3]; OR, 1.49 [95% CI, 1.15-1.92]; and OR, 1.21 [95% CI, 0.93-1.57]; respectively).CONCLUSIONS AND RELEVANCE Younger age was associated with higher 30-day mortality rates in women with STEMI even after adjustment for medications, primary PCI, and other coexisting comorbidities. This difference declines after age 60 and is no longer observed in oldest women.