目的:急性心肌梗死患者的性别差异仍存在争议。陈述中的不平等,诊断,治疗,经常观察到预后,导致女性预后较差。这项研究的目的是调查葡萄牙ST段抬高型心肌梗死(STEMI)患者的性别相关差异。
方法:作者对葡萄牙急性冠状动脉综合征注册中的STEMI患者进行了回顾性分析,2010年10月至2022年。两个共同的主要终点是住院和一年死亡率。
结果:共研究了14470例STEMI患者。妇女人数不足,有3721人(25.7%)。他们年龄明显较大(70vs.62年,p<0.001),心血管危险因素的患病率较高,并且接受冠状动脉造影的频率较低(84.4%vs.88.5%,p<0.001)和指南指导的药物治疗(例如,阿司匹林92.5%vs.95.4%,β受体阻滞剂79.2%vs.83%,p<0.001。此外,他们经历了更多的并发症,如充血性心力衰竭(23.4%vs.14.6%),缺血性卒中(47vs.40%),和住院死亡率(8.5%vs.4.1%)(所有比较的p<0.001)。同样,他们的一年死亡率较高(11.5%vs.6.3,p<0.001)。然而,在多变量分析测试了重要的临床变量后,女性仍然是住院的独立预测因子(比值比=1.633;CI95%[1.065-2.504];p=0.025),但不是一年死亡率。
结论:该分析揭示了葡萄牙STEMI患者的性别相关差异。尽管基于注册表的分析固有的局限性,女性年龄明显较大,心血管风险增加,少处理,住院死亡率更高。这些差异应该是临床医生进一步改善结果并迈向公平医疗的担忧。
OBJECTIVE: Sex differences among patients with acute myocardial infarctions remain a matter of debate. Inequalities in presentation, diagnosis, treatment, and prognosis are frequently observed, contributing to a worse prognosis in women. The aim of this study was to investigate sex-related differences in Portuguese ST-segment elevation myocardial infarction (STEMI) patients.
METHODS: The authors conducted a retrospective analysis of STEMI patients included in the Portuguese Registry on Acute Coronary Syndromes, between October 2010 and 2022. The two co-primary endpoints were in-hospital and one-year mortality.
RESULTS: A total of 14470 STEMI patients were studied. Women were underrepresented with 3721 individuals (25.7%). They were significantly older (70 vs. 62 years, p<0.001), with higher prevalence of cardiovascular risk factors, and underwent less frequently coronary angiography (84.4% vs. 88.5%, p<0.001) and guideline-directed medical therapy (e.g., aspirin 92.5% vs. 95.4%, beta blockers 79.2% vs. 83%, p<0.001. Furthermore, they experienced more complications, such as congestive heart failure (23.4% vs. 14.6%), ischemic stroke (47 vs. 40%), and in-hospital mortality (8.5% vs. 4.1%) (p<0.001 for all comparisons). Similarly, they presented higher one-year mortality (11.5% vs. 6.3, p<0.001). However, after a multivariate analysis testing significant clinical variables, female sex remained an independent predictor for in-hospital (odds ratio=1.633; CI 95% [1.065-2.504]; p=0.025), but not for one-year mortality.
CONCLUSIONS: This analysis reveals sex-related disparities in Portuguese STEMI patients. Despite limitations inherent to registry-based analysis, women were significantly older, with increased cardiovascular risk, less treated, and with higher in-hospital mortality. These disparities should be a concern for clinicians to further improve outcomes and move toward equitable medical care.