Delayed Care and Mortality Among Women and Men With Myocardial Infarction.
Delayed Care and Mortality Among Women and Men With Myocardial Infarction.
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DOI：
10.1161/jaha.117.005968
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发表时间：
2017-08-21
影响因子：
5.4
通讯作者：
Badimon L
中科院分区：
文献类型：
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作者：
Bugiardini R;Ricci B;Cenko E;Vasiljevic Z;Kedev S;Davidovic G;Zdravkovic M;Miličić D;Dilic M;Manfrini O;Koller A;Badimon L
女性ST段抬高心肌梗死(STEMI)的死亡率高于男性。我们调查了STEMI患者在及时获得护理方面的性别差异是否可能是女性早期死亡风险过高的一个因素。我们确定了从2010年10月到2016年4月期间，参与ISACS-TC(转型国家急性冠脉综合征国际调查)登记(NCT01218776)的41家医院的6022名STEMI患者，他们拥有关于症状出现时间和住院时间的信息。患者被分成时间延迟队列。我们估计了每个队列中全因死亡的30天风险。尽管在寻求治疗方面出现了类似的延误，但女性从出现症状到住院表现的总体时间比男性长(中位数：270分钟[范围：130-776]对240分钟[范围：120-600])。在调整了基线变量后，女性与30天内死亡的风险独立相关(优势比：1.58；95%可信区间，1.27-1.97)。STEMI后死亡率的性别差异不再被观察到从症状出现到入院≤每小时延迟的患者(优势比：0.77；95%可信区间，0.29-2.02)。STEMI后死亡率的性别差异仍然存在，而且似乎是由院前就诊延迟引起的。女性似乎更容易受到长期未经治疗的缺血的影响。网址：https://www.clinicaltrials.gov/.唯一标识：NCT01218776。
Women with ST‐segment–elevation myocardial infarction (STEMI) have higher mortality rates than men. We investigated whether sex‐related differences in timely access to care among STEMI patients may be a factor associated with excess risk of early mortality in women. We identified 6022 STEMI patients who had information on time of symptom onset to time of hospital presentation at 41 hospitals participating in the ISACS‐TC (International Survey of Acute Coronary Syndromes in Transitional Countries) registry (NCT01218776) from October 2010 through April 2016. Patients were stratified into time‐delay cohorts. We estimated the 30‐day risk of all‐cause mortality in each cohort. Despite similar delays in seeking care, the overall time from symptom onset to hospital presentation was longer for women than men (median: 270 minutes [range: 130–776] versus 240 minutes [range: 120–600]). After adjustment for baseline variables, female sex was independently associated with greater risk of 30‐day mortality (odds ratio: 1.58; 95% confidence interval, 1.27–1.97). Sex differences in mortality following STEMI were no longer observed for patients having delays from symptom onset to hospital presentation of ≤1 hour (odds ratio: 0.77; 95% confidence interval, 0.29–2.02). Sex difference in mortality following STEMI persists and appears to be driven by prehospital delays in hospital presentation. Women appear to be more vulnerable to prolonged untreated ischemia. URL: https://www.clinicaltrials.gov/. Unique identifier: NCT01218776.