PDF(Pubmed)
Abstract：
Background: Specifically young women are at risk for a poor outcome after ST-elevation myocardial infarction (STEMI). We aimed to investigate sex- and age-specific differences in outcome and associate these results with adherence to a guideline-directed optimal medical therapy (OMT). Methods: Administrative insurance data (≈26 million insured) were screened for patients aged 18-60 years with STEMI. Patient demographics, details on in-hospital treatment, adherence to OMT and its effect on mortality were assessed. Adherence to OMT was analyzed using multistate models and an association of those with death was fitted using multivariable Cox regression models with time-dependent co-variables. Results: Overall, 59,401 patients (19.3% women), median age 52 (interquartile range 48, 56) presented with STEMI. Female sex was associated with a poor outcome early after STEMI (90-day mortality: odds ratio 1.22, 95% confidence interval (CI) 1.12-1.32, p < 0.001). Overall survival was reduced in women compared to same-aged men. The ten-year survival rate was 19.7% (18.1-21.2%) versus 19.6% (18.9-20.4%) in men (p < 0.001). Although long-term drug adherence was low, its intake was associated with a better outcome. Specifically younger women showed a markedly lower mortality when on OMT (hazard ratio (HR) 0.22 (95% CI 0.19-0.26) versus HR 0.31 (95% CI 0.28-0.33) in men, pint < 0.001). Conclusions: Specifically young women were at risk for a poor outcome in the early phase after STEMI. Although long-term adherence to OMT was low, it was generally associated with a lower mortality, specifically in women. Our findings emphasize on early and long-term preventive measures in all patients after STEMI.
摘要：
背景：特别是年轻女性在ST段抬高型心肌梗死（STEMI）后存在预后不良的风险。我们旨在调查性别和年龄特异性结果的差异，并将这些结果与遵循指南指导的最佳药物治疗（OMT）相关联。方法：为18-60岁的STEMI患者筛选行政保险数据（约2600万被保险人）。患者人口统计学，关于住院治疗的细节，对OMT的依从性及其对死亡率的影响进行了评估.使用多状态模型分析了对OMT的依从性，并使用具有时间依赖性共变量的多变量Cox回归模型拟合了与死亡的关联。结果：总体而言，59,401名患者（19.3％为女性），STEMI患者的中位年龄52岁(四分位距48、56)。女性性别与STEMI后早期不良结局相关（90天死亡率：比值比1.22，95％置信区间（CI）1.12-1.32，p<0.001）。与同龄男性相比，女性的总生存率降低。男性的十年生存率为19.7％（18.1-21.2％），而男性为19.6％（18.9-20.4％）（p<0.001）。尽管长期的药物依从性很低，它的摄入量与更好的结果相关。特别是年轻女性在OMT（风险比（HR）0.22（95％CI0.19-0.26）与男性HR0.31（95％CI0.28-0.33）时，死亡率显着降低，品脱<0.001)。结论：特别是年轻女性在STEMI后的早期阶段有不良预后的风险。尽管OMT的长期依从性很低，它通常与较低的死亡率有关，特别是在女性。我们的发现强调了STEMI后所有患者的早期和长期预防措施。
