BackgroundHistorically, 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.MethodsComparisons 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.ResultsOverall, 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.ConclusionSmall 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.

中文翻译：

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STEMI 治疗中的性别差异以及当代直接 PCI 的结果


背景历史上，患有 ST 段抬高型心肌梗死 (STEMI) 的女性在及时再灌注和结果方面存在差异。然而，当代经皮冠状动脉介入治疗 (PCI) 策略对 STEMI 患者的治疗已经取得了进步。 方法对 4 年期间（2017 年 1 月 1 日至 2020 年 12 月 31 日）接受直接 PCI 治疗的 STEMI 患者进行性别比较）来自昆士兰心脏结果登记处。主要结局是 30 天和 1 年心血管死亡率。次要结果是 STEMI 表现测量。使用逻辑斯蒂和多项逻辑回归模型估计性别对死亡率结果的总体和直接影响。结果总体而言，纳入了 2747 人（76% 男性）。女性平均年龄较大（65.9 岁 vs. 61.9 岁；p < 0.001），总缺血时间较长（69 分钟 vs. 52 分钟；p < 0.001），STEMI 性能目标的实现率较低（<90 分钟）（50 % 与 58%；p < 0.001）。没有证据表明总体（比值比 [OR] 1.3（95% 置信区间 [CI]：0.8–2.2；p = 0.35）或直接（调整后 OR 1.2（95% CI：0.7–2.1；p = 0.58））女性对 30 天死亡率的影响。女性一年死亡率较高（6.9% vs. 4.4%；p = 0.014），总效应估计与心血管死亡风险增加一致（发病率比 [IRR]：1.5） ； 95% CI：1.0–2.3；p = 0.059）和非心血管死亡率（IRR：2.1；95% CI：0.9–4.7；p = 0.077）。 1.0；95% CI：0.6–1.6；p = 0.94）表明性别差异由混杂因素和中介因素解释。结论 STEMI 表现测量中仍然存在较小的性别差异；然而，在当代主要 PCI 策略中，性别与 30 天或 1 年心血管死亡率无关。