The influence of biological age and sex on long-term outcome after percutaneous coronary intervention for ST-elevation myocardial infarction.

Autor:	Rathod KS; Barts Health NHS Trust London, United Kingdom.; William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London London, United Kingdom., Jones DA; Barts Health NHS Trust London, United Kingdom.; William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London London, United Kingdom., Jain AK; Barts Health NHS Trust London, United Kingdom., Lim P; St. George's Healthcare NHS Foundation Trust, St. George's Hospital London, United Kingdom., MacCarthy PA; Kings College Hospital, King's College Hospital NHS Foundation Trust Denmark Hill, London, United Kingdom., Rakhit R; Royal Free London NHS Foundation Trust Pond Street, London, United Kingdom., Lockie T; Royal Free London NHS Foundation Trust Pond Street, London, United Kingdom., Kalra S; Royal Free London NHS Foundation Trust Pond Street, London, United Kingdom., Dalby MC; Royal Brompton & Harefield NHS Foundation Trust, Harefield Hospital Hill End Road, Middlesex, United Kingdom., Malik IS; Imperial College Healthcare NHS Foundation Trust, Hammersmith Hospital Du Cane Road, London, United Kingdom., Whitbread M; London Ambulance Service NHS Trust London, United Kingdom., Firoozi S; St. George's Healthcare NHS Foundation Trust, St. George's Hospital London, United Kingdom., Bogle R; St. George's Healthcare NHS Foundation Trust, St. George's Hospital London, United Kingdom., Redwood S; St. Thomas' NHS Foundation Trust, Guys & St. Thomas Hospital Westminster Bridge Rd, London, United Kingdom., Cooper J; William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London London, United Kingdom., Gupta A; Barts Health NHS Trust London, United Kingdom.; William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London London, United Kingdom., Lansky A; Barts Health NHS Trust London, United Kingdom.; William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London London, United Kingdom.; Section of Cardiology, Yale University School of Medicine New Haven CT, USA., Wragg A; Barts Health NHS Trust London, United Kingdom., Mathur A; Barts Health NHS Trust London, United Kingdom.; William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London London, United Kingdom., Ahluwalia A; William Harvey Research Institute, Barts & The London School of Medicine & Dentistry, Queen Mary University of London London, United Kingdom.
Jazyk:	angličtina
Zdroj:	American journal of cardiovascular disease [Am J Cardiovasc Dis] 2021 Oct 25; Vol. 11 (5), pp. 659-678. Date of Electronic Publication: 2021 Oct 25 (Print Publication: 2021).
Abstrakt:	Background: Outcome following ST-segment elevation myocardial infarction (STEMI) is thought to be worse in women than in age-matched men. We assessed whether such differences occur in the UK Pan-London dataset and if age, and particularly menopause, influences upon outcome. Methods: We undertook an observational cohort study of 26,799 STEMI patients (20,633 men, 6,166 women) between 2005-2015 at 8 centres across London, UK. Patient details were recorded at the time of the procedure into local databases using the British Cardiac Intervention Society (BCIS) PCI dataset. Primary outcome was all-cause mortality at a median follow-up of 4.1 years (IQR: 2.2-5.8 years). Results: Kaplan-Meier analysis demonstrated a higher mortality rate in women versus men (15.6% men vs. 25.3% women, P<0.0001). Univariate Cox analysis revealed that female sex was a predictor of all-cause mortality (HR: 1.69 95% CI: 1.59-1.82). However, after multivariate adjustment, this effect of female sex diminished (HR: 1.05 95% CI: 0.90-1.25). In a sub-group analysis, we compared the sexes separated by age into the ≤55 and the >55 year olds. Age-stratified Cox analysis revealed that female sex was a univariate predictor of all-cause mortality (HR: 1.60 95% CI: 1.25-2.05) in the ≤55 group and in the >55 group (HR: 1.38 95% CI: 1.28-1.47). However, after regression adjustment incorporating the propensity score into a proportional hazard model as a covariate, whilst female sex was not a significant predictor of all-cause mortality in the ≤55 group it was a predictor in the >55 group. Moreover, whilst age did not influence outcome in <55 group, this effect in the >55 group was correlated with age. Conclusions: Overall women have a worse all-cause mortality following primary PCI for STEMI compared to men. However, this effect was driven predominantly by women >55 years of age since after adjusting for co-morbidities the risk in younger women did not differ significantly from that in men. These observations support the view that as women advance past the menopausal years their risk of further events following revascularization increases substantially and we suggest that routine assessment of hormonal status may improve clinical decision-making and ultimately outcome for women post-PCI. Competing Interests: None. (AJCD Copyright © 2021.)
Databáze:	MEDLINE
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