Sex Differences in Reperfusion in Young Patients With ST-Segment-Elevation Myocardial Infarction Results From the VIRGO Study
Sex Differences in Reperfusion in Young Patients With ST-Segment-Elevation Myocardial Infarction Results From the VIRGO Study
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DOI：
10.1161/circulationaha.114.012293
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发表时间：
2015-04-14
期刊：
影响因子：
37.8
通讯作者：
Krumholz, Harlan M.
中科院分区：
文献类型：
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作者：
D'Onofrio, Gail;Safdar, Basmah;Krumholz, Harlan M.
背景-急性ST段抬高型心肌梗死患者再灌注治疗的性别差异已被证实。然而，很少有人知道这些模式是否存在于年轻女性与男性的比较。方法和结果-我们检查了性别差异的比率，类型的再灌注治疗，在一项前瞻性观察性队列研究中，超过美国心脏协会ST段抬高型心肌梗死再灌注时间指南的患者比例（2008-2012年），1465例18 - 55岁的患者，作为美国恢复变化：性别对年轻AMI患者结局的作用（VIRGO）研究的一部分，在103家医院招募，男女比例为2：1。在1238例符合再灌注条件的患者中，女性比男性更可能未经治疗（9%对4%，P=0.002）。接受治疗的695名女性和458名男性的再灌注策略没有差异。女性比男性更可能超过经皮冠状动脉介入治疗的住院和转运时间指南（41%对29%;比值比，1.65; 95%置信区间，1.27-2.16），转移时更是如此（67%对44%;比值比，2.63; 95%置信区间，1.17-4.07）;更有可能超过门到针的时间（67%对37%;比值比，2.62; 95%置信区间，1.23-2.18）。调整后的社会人口，临床和组织因素，性别仍然是一个重要因素，超过再灌注指南（比值比，1.72; 95%置信区间，1.28-2.33）conclusions年轻女性ST段抬高心肌梗死是不太可能接受再灌注治疗，更有可能比同龄男性再灌注延迟。性别差异在转入经皮冠状动脉介入治疗机构或接受纤溶治疗的患者中更为明显。
Background-Sex disparities in reperfusion therapy for patients with acute ST-segment-elevation myocardial infarction have been documented. However, little is known about whether these patterns exist in the comparison of young women with men.Methods and Results-We examined sex differences in rates, types of reperfusion therapy, and proportion of patients exceeding American Heart Association reperfusion time guidelines for ST-segment-elevation myocardial infarction in a prospective observational cohort study (2008-2012) of 1465 patients 18 to 55 years of age, as part of the US Variations in Recovery: Role of Gender on Outcomes of Young AMI Patients (VIRGO) study at 103 hospitals enrolling in a 2:1 ratio of women to men. Of the 1238 patients eligible for reperfusion, women were more likely to be untreated than men (9% versus 4%, P=0.002). There was no difference in reperfusion strategy for the 695 women and 458 men treated. Women were more likely to exceed in-hospital and transfer time guidelines for percutaneous coronary intervention than men (41% versus 29%; odds ratio, 1.65; 95% confidence interval, 1.27-2.16), more so when transferred (67% versus 44%; odds ratio, 2.63; 95% confidence interval, 1.17-4.07); and more likely to exceed door-to-needle times (67% versus 37%; odds ratio, 2.62; 95% confidence interval, 1.23-2.18). After adjustment for sociodemographic, clinical, and organizational factors, sex remained an important factor in exceeding reperfusion guidelines (odds ratio, 1.72; 95% confidence interval, 1.28-2.33).Conclusions-Young women with ST-segment-elevation myocardial infarction are less likely to receive reperfusion therapy and more likely to have reperfusion delays than similarly aged men. Sex disparities are more pronounced among patients transferred to percutaneous coronary intervention institutions or who received fibrinolytic therapy.