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Title: Sex-Related Differences in Short- and Long-Term Outcome among Young and Middle-Aged Patients for ST-Segment Elevation Myocardial Infarction Underwent Percutaneous Coronary Intervention.
Author: Fu WX, Zhou TN, Wang XZ, Zhang L, Jing QM, Han YL.
Journal: Chin Med J (Engl); 2018 Jun 20; 131(12):1420-1429. PubMed ID: 29893358.
Abstract:
BACKGROUND: Females with ST-segment elevation myocardial infarction (STEMI) have higher in-hospital and short-term mortality rates compared with males in China, suggesting that a sex disparity exists. The age of onset of STEMI is ahead of time and tends to be younger. However, there are relatively little data on the significance of sex on prognosis for long-term outcomes for adult patients with STEMI after percutaneous coronary intervention (PCI) in China. This study sought to analyze the sex differences in 30-day, 1-year, and long-term net adverse clinical events (NACEs) in Chinese adult patients with STEMI after PCI. METHODS: This study retrospectively analyzed 1920 consecutive STEMI patients (age ≤60 years) treated with PCI from January 01, 2006, to December 31, 2012. A propensity score analysis between males and females was performed to adjust for differences in baseline characteristics and comorbidities. The primary endpoint was the incidence of 3-year NACE. Survival curves were constructed with Kaplan-Meier estimates and compared by log-rank tests between the two groups. Multivariate analysis was performed using a Cox proportional hazards model for 3-year NACE. RESULTS: Compared with males, females had higher risk profiles associated with old age, longer prehospital delay at the onset of STEMI, hypertension, diabetes mellitus, and chronic kidney disease, and a higher Killip class (≥3), with more multivessel diseases (P < 0.05). The female group had a higher levels of low-density lipoprotein (2.72 [2.27, 3.29] vs. 2.53 [2.12, 3.00], P < 0.001), high-density lipoprotein (1.43 [1.23, 1.71] vs. 1.36 [1.11, 1.63], P = 0.003), total cholesterol (4.98 ± 1.10 vs. 4.70 ± 1.15, t = -3.508, P < 0.001), and estimated glomerular filtration rate (103.12 ± 22.22 vs. 87.55 ± 18.03, t = -11.834, P < 0.001) than the male group. In the propensity-matched analysis, being female was associated with a higher risk for 3-year NACE and major adverse cardiac or cerebral events compared with males. In the multivariate model, female gender (hazard ratio [HR]: 2.557, 95% confidence interval [CI]: 1.415-4.620, P = 0.002), hypertension (HR: 2.017, 95% CI: 1.138-3.576, P = 0.016), and family history of coronary heart disease (HR: 2.256, 95% CI: 1.115-4.566, P = 0.024) were independent risk factors for NACE. The number of stents (HR: 0.625, 95% CI: 0.437-0.894, P = 0.010) was independent protective factors of NACE. CONCLUSIONS: Females with STEMI undergoing PCI have a significantly higher risk for 3-year NACE compared with males in this population. Sex differences appear to be a risk factor and present diagnostic challenges for clinicians. 中青年急性ST段抬高心肌梗死患者行急诊PCI的预后的性别差异研究摘要背景：在中国，急性ST段抬高型心肌梗死（ST-elevation myocardial infarction,STEMI）的女性住院率和短期死亡率高于男性，这表明性别之间存在差异。目前，STEMI发病年龄提前，存在年轻化的趋势。因此，尚不明确性别对STEMI患者行急诊经皮冠状动脉介入治疗（primary percutaneous coronary intervention, PPCI）术后的远期疗效是否存在性别差异。本研究探讨中青年STEMI患者行急诊PCI治疗的临床特征及术后随访30天、1年、3年的净不良临床事件（net adverse clinical event，NACE）的发生情况，旨在评价性别对中青年STEMI患者行急诊PCI的近期和远期预后的差异。 方法： 回顾性收集沈阳军区总医院从2006年1月至2012年12月年龄≤60岁的STEMI患者行急诊PCI治疗的1920例，按照性别分为两组，采用倾向性评分校正不同性别患者年龄及合并症等基线资料差异后，进一步分析性别对STEMI患者行PPCI术后的预后差异。主要研究终点为3年NACE 发生情况，并应用Kaplan-Meier曲线评价两组患者的预后不良事件的发生率，应用log-rank P检验。应用Cox比例风险模型观察性别对术后3年NACE发生风险的预后独立影响因素。 结果： 与男性患者比较，女性平均年龄较男性大，症状发作到入院时间延长，合并患有高血压、糖尿病、慢性肾脏病（P <0.05）,且吸烟史、Killip ≥3级及三支血管病变比例较高（P <0.05）。女性低密度脂蛋白[low density lipoprotein,LDL;2.72(2.27,3.29) vs. 2.53(2.12,3.00), P<0.001], 高密度脂蛋白[high density lipoprotein,HDL;1.43(1.23,1.71) vs.1.36(1.11,1.63), P=0.003]，胆固醇(total cholesterol,TC；4.98±1.10 vs. 4.70±1.15, t=-3.508, P <0.001)，估计肾小球滤过率（estimated glomerular filtration rate， eGFR;103.12±22.22 vs. 87.55±18.03, t=-11.834, P <0.001) 水平高于男性组，采用倾向性评分校正不同性别患者的年龄及合并症等临床特征后，不同性别的患者术后30天、1年NACE 和主要不良心脑血管事件(major adverse cardiac or cerebral events ,MACCE)的发生率差异没有统计学意义，3年发生NACE和MACCE仍有统计学显著性差异。COX多因素分析显示，女性[风险比（HR）:2.557，95% 可信区间（CI）：1.415-4.620，P=0.002],高血压(HR：2.017，95% CI： 1.138-3.576，P=0.016)，冠心病家族史(HR：2.256，95% CI：1.115-4.566，P=0.024)是3 年NACE预后独立危险因素。支架数目是(HR: 0.625，95% CI:0.437-0.894，P=0.010) 3年NACE 预后保护因素。结论：中青年女性STEMI患者行急诊PCI术后近期临床结局和男性相当，远期预后较差，因此需要考虑到这个特定的危险群体，需要长期关注中青年女性STEMI患者。.

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