STEMI 治疗中的性别差异和当代初级 PCI 的疗效。

IF 2.1 3区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Catheterization and Cardiovascular Interventions Pub Date : 2024-11-01 Epub Date: 2024-09-03 DOI:10.1002/ccd.31206
Michael L Savage, Karen Hay, William Vollbon, Dale J Murdoch, Christopher Hammett, James Crowhurst, Karl Poon, Rohan Poulter, Darren L Walters, Russell Denman, Isuru Ranasinghe, Owen Christopher Raffel
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引用次数: 0

摘要

背景:从历史上看,女性 ST 段抬高型心肌梗死(STEMI)患者在及时再灌注和预后方面存在差异。然而,采用现代经皮冠状动脉介入治疗(PCI)策略治疗 STEMI 患者的效果有所改善:方法:对昆士兰心脏结果登记处在 4 年内(2017 年 1 月 1 日至 2020 年 12 月 31 日)接受初级 PCI 治疗的 STEMI 患者进行性别比较。主要结果为 30 天和 1 年心血管死亡率。次要结果为 STEMI 性能指标。采用逻辑和多叉逻辑回归模型估算了性别对死亡率结果的总影响和直接影响:总共纳入了 2747 名患者(76% 为男性)。女性平均年龄较大(65.9 岁对 61.9 岁;P 结论:在 STEMI 指标中,性别差异较小:在 STEMI 的绩效衡量中,仍然存在微小的性别差异;但是,采用现代的初级 PCI 策略,性别与 30 天或 1 年的心血管死亡率无关。
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Differences between sexes in STEMI treatment and outcomes with contemporary primary PCI.

Background: Historically, differences in timely reperfusion and outcomes have been described in females who suffer ST-segment elevation myocardial infarction (STEMI). However, there have been improvements in the treatment of STEMI patients with contemporary Percutaneous Coronary Intervention (PCI) strategies.

Methods: Comparisons between sexes were performed on STEMI patients treated with primary PCI over a 4-year period (January 1, 2017-December 31, 2020) from the Queensland Cardiac Outcomes Registry. Primary outcomes were 30-day and 1-year cardiovascular mortality. Secondary outcomes were STEMI performance measures. The total and direct effects of gender on mortality outcomes were estimated using logistic and multinomial logistic regression models.

Results: Overall, 2747 (76% male) were included. Females were on average older (65.9 vs. 61.9 years; p < 0.001), had longer total ischemic time (69 min vs. 52 min; p < 0.001) and less achievement of STEMI performance targets (<90 min) (50% vs. 58%; p < 0.001). There was no evidence for a total (odds ratio [OR] 1.3 (95% confidence interval [CI]: 0.8-2.2; p = 0.35) or direct (adjusted OR 1.2 (95% CI: 0.7-2.1; p = 0.58) effect of female sex on 30-day mortality. One-year mortality was higher in females (6.9% vs. 4.4%; p = 0.014) with total effect estimates consistent with increased risk of cardiovascular mortality (Incidence rate ratio [IRR]: 1.5; 95% CI: 1.0-2.3; p = 0.059) and noncardiovascular mortality (IRR: 2.1; 95% CI: 0.9-4.7; p = 0.077) in females. However, direct (adjusted) effect estimates of cardiovascular mortality (IRR: 1.0; 95% CI: 0.6-1.6; p = 0.94) indicated sex differences were explained by confounders and mediators.

Conclusion: Small sex differences in STEMI performance measures still exist; however, with contemporary primary PCI strategies, sex is not associated with cardiovascular mortality at 30 days or 1 year.

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来源期刊
CiteScore
5.40
自引率
8.70%
发文量
419
审稿时长
2 months
期刊介绍: Catheterization and Cardiovascular Interventions is an international journal covering the broad field of cardiovascular diseases. Subject material includes basic and clinical information that is derived from or related to invasive and interventional coronary or peripheral vascular techniques. The journal focuses on material that will be of immediate practical value to physicians providing patient care in the clinical laboratory setting. To accomplish this, the journal publishes Preliminary Reports and Work In Progress articles that complement the traditional Original Studies, Case Reports, and Comprehensive Reviews. Perspective and insight concerning controversial subjects and evolving technologies are provided regularly through Editorial Commentaries furnished by members of the Editorial Board and other experts. Articles are subject to double-blind peer review and complete editorial evaluation prior to any decision regarding acceptability.
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