The joint contribution of sex, age and type of myocardial infarction on hospital mortality following acute myocardial infarction
The joint contribution of sex, age and type of myocardial infarction on hospital mortality following acute myocardial infarction
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DOI：
10.1136/hrt.2008.155804
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发表时间：
2009-06-01
期刊：
影响因子：
5.7
通讯作者：
Vaccarino, V.
中科院分区：
文献类型：
--
作者：
Champney, K. P.;Frederick, P. D.;Vaccarino, V.
目的：年轻女性心肌梗死（MI）后的死亡率高于同龄男性，而不是老年女性。我们试图确定这种关系是否适用于ST段抬高型心肌梗死（STEMI）和非ST段抬高型心肌梗死（NSTEMI）。设计：回顾性队列研究。背景：2000年至2006年间1057家美国医院参与心肌梗死国家登记。患者：STEMI患者126 172例，NSTEMI患者235 257例。主要结局指标：医院死亡。结果：对于STEMI和NSTEMI，患者年龄越年轻，女性与男性相比的额外死亡风险越大，而老年女性的表现与男性相似（STEMI）或更好（NSTEMI）（年龄-性别相互作用p < 0.0001）。在STEMI中，年龄、50岁、50-59岁、60-69岁、70-79岁和80-89岁的未调整女性对男性的RR分别为1.68 （95% CI 1.41 - 2.01）、1.78 （95% CI 1.59 - 1.99）、1.45 （95% CI 1.34 - 1.57）、1.08 （95% CI 1.02 - 1.14）和1.03 （95% CI 0.98 - 1.07）。对于NSTEMI，相应的未经调整的rr分别为1.56（1.31 ~ 1.85）、1.42（1.27 ~ 1.58）、1.17（1.09 ~ 1.25）、0.92（0.88 ~ 0.96）和0.86（0.83 ~ 0.89）。在调整了风险状态后，年轻女性与男性相比的额外风险降低到大约15-20%，而老年NSTEMI女性与男性相比的生存率更高。结论：在STEMI和NSTEMI患者中，短期死亡率的性别相关差异是年龄依赖性的。
Objective: Younger, but not older, women have a higher mortality than men of similar age after a myocardial infarction (MI). We sought to determine whether this relationship is true for both ST elevation MI (STEMI) and non-ST elevation MI (NSTEMI).Design: Retrospective cohort study.Setting: 1057 USA hospitals participant in the National Registry of Myocardial Infarction between 2000 and 2006.Patients: 126 172 STEMI and 235 257 NSTEMI patients.Main outcome measure: Hospital death.Results: For both STEMI and NSTEMI, the younger the patient's age, the greater the excess mortality risk for women compared with men, while older women fared similarly (STEMI) or better (NSTEMI) than men (p < 0.0001 for the age-sex interaction). In STEMI, the unadjusted women-to-men RR was 1.68 (95% CI 1.41 to 2.01), 1.78 (1.59 to 1.99), 1.45 (1.34 to 1.57), 1.08 (1.02 to 1.14) and 1.03 (0.98 to 1.07) for age,50 years, age 50-59, age 60-69, age 70-79 and age 80-89, respectively. For NSTEMI, corresponding unadjusted RRs were 1.56 (1.31 to 1.85), 1.42 (1.27 to 1.58), 1.17 (1.09 to 1.25), 0.92 (0.88 to 0.96) and 0.86 (0.83 to 0.89). After adjusting for risk status, the excess risk for younger women compared with men decreased to approximately 15-20%, while a better survival of older NSTEMI women compared with men persisted.Conclusions: Sex-related differences in short-term mortality are age-dependent in both STEMI and NSTEMI patients.