Gender Differences In Clinical Characteristics,diagnosis,treatments And In-hospital Outcomes Of Patients With ST-segment Elevation Myocardial Infarction Undergoing Primary Percutaneous Coronary Intervention In China

ObjectiveTo explore the gender differences in the clinical characteristics,diagnosis,treatments and in-hospital outcomes of patients with ST-segment elevation myocardial infarction(STEMI)undergoing direct percutaneous coronary intervention(PPCI)in China.Provide basis for diagnosis and treatment and clinical outcome of female patients with acute myocardial infarction.Methods1.The data comes from China PEACE retrospective AMI study.The study used a two-stage random sampling to obtain a national representative sample of 1521 inpatients who underwent PPCI due to STEMI in 2015 from hospitals,including 330 female patients(21.7%)and 1191 male patients(78.3%).2.Perform centralized information extraction on the obtained medical records,and analyze the gender differences in patients’ clinical characteristics,diagnosis and treatment modes,and hospital outcomes.3.Use multivariate regression analysis to explore whether gender is an independent risk factor for in-hospital treatment and outcome.Results1.In terms of clinical characteristics,women are older than men on average(67.5 years vs 58.8 years,P<0.05),hypertension(60.0% vs 50.4%,P<0.05),diabetes(30.0% vs 21.8%,P<0.05).The prevalence of was higher than that of men,but the smoking rate(12.7% vs 56.7%,P<0.01),the rate of LDL-C<130mg/dl(73.0% vs79.4%,P<0.05),and the level of eGFR(93.4 vs 97.4,P<0.05)is lower than that of men.And female patients are more likely to have systolic blood pressure ≥140mm Hg when they are admitted to the hospital(37.0% vs 30.1%,P<0.05).The proportion of women with previous myocardial infarction(2.1% vs 4.8%,P<0.05)and PCI treatment history(3.0% vs 5.8%,P<0.05)was lower than that of men.At the same time,the proportion of women with previous stroke(13.3% vs 9.8%,P>0.05)and chronic kidney disease(1.5% vs 1.0%,P>0.05)was higher than that of men,but the difference was not statistically significant.During the entire hospital stay,females had a higher mini-GRACE score than males(144.4±23.9 vs 131.3±25.2,P<0.01).2.In terms of diagnosis and treatments,compared with men,women have a higher treatment rate of β-blockers in the acute phase(54.4% vs 45.7%,P<0.05),while adjusting for age,cardiovascular risk factors(hypertension,Diabetes,smoking,LDL-C level),medical history(coronary heart disease,myocardial infarction,PCI,stroke),clinical characteristics at admission(chest discomfort,cardiogenic shock,heart rate,eGFR),economic geographic area,city,mini-GRACE score,the gender difference disappeared(OR 1.09,95%CI 0.80～1.49).There were no significant gender differences in the use of aspirin(82.2% vs 82.5%,P>0.05),clopidogrel/ticagrelor(85.2% vs 86.1%,P>0.05),ACEI or ARB(57.5% vs 58.4%,P>0.05),and statins(92.1% vs 91.9%,P>0.05).3.The rate of women was higher than rate of men in terms of death(2.7% vs1.7%,P=0.22),death or withdrawal from treatment(3.6% vs 2.7%,P=0.36),bleeding(12.7% vs 9.9%,P=0.14)and composite complications(10% vs 8.6%,P=0.45).After adjusting for diabetes,eGFR,and mini-GRACE scores,there was no statistical differences between women and men.ConclusionAmong STEMI patients undergoing PPCI,although women are older and have a higher proportion of cardiovascular risk factors,there are no significant differences in diagnosis,treatments and in-hospital outcomes.Based on the above findings,it is suggested to pay attention to female cardiovascular disease and strengthen the prevention and control of risk factors in female patients,which may further benefit the prognosis of women on the basis of PPCI.