Gender Difference Of In-hospital Mortality Among Patients With Acute ST-segment Elevation Myocardial Infarction

Objectives:To explore the influence of gender on in-hospital mortality of STEMI patients.Methods:1.7646 STEMI patients diagnosed by our hospital from January 2013 to June 2018 were selected,including 5338 male patients(69.8%)and 2308(30.2%)female patients.2.The differences of baseline data and in-hospital mortality between male and female in STEMI group were compared to explore the influence of gender on in-hospital mortality.3.All STEMI patients were divided into PCI group and non-PCI group.The differences of baseline data and in-hospital mortality between male and female in PCI group were compared to explore the influence of gender on in-hospital mortality.3.According to the United Nations World Health Organization(WHO)age classification criteria in 2018,PCI group patients were divided into two subgroups: young group(18-65 years old),elderly group(> 65 years old).The difference of baseline data and in-hospital mortality between male and female in young group and elderly group were compared.To explore the influence of gender on in-hospital mortality of each group.Result:1.The in-hospital mortality of female in STEMI group was higher than that of male(4.4%: 2.9%,P = 0.001).After multifactor regression of in-hospital mortality was performed,gender was not an independent risk factor(OR=0.766;95%CI:0.568-1.032,P=0.080)。2.In PCI and non-PCI group,the mortality rate of female was higher than that of male(2.3%: 1.1%,P = 0.001,7.6%: 6.7%,P = 0.397).Multifactor regression for all-cause in-hospital mortality was performed in PCI group.Age,anterior myocardial infarction,and Killip classification ≥ III were independent risk factors,and ACEI/ARB,β-blocker were protective factors.Although the in-hospital mortality for female patients was 1.289 times of male,the effect of gender of in-hospital mortality did not reach statistical significance(OR=1.289;95%CI:0.767-2.168,P=0.338).3.The mortality rate of female in PCI young group was higher than that of male(0.90%: 0.87%,P = 0.938).Multifactor regression was conducted for in-hospital mortality in PCI young group.Age,anterior myocardial infarction,Killip classification ≥ III,and RCA lesions were independent risk factors.Statins and β-blockers were protective factors.Women was not the independent risk factor for in-hospital mortality(OR=0.707;95%CI:0.287-1.738,P=0.449).4.The mortality rate of female in PCI elderly group was higher than that of male(4.1%: 1.8%,P = 0.011).Multifactor regression was conducted for in-hospital mortality in PCI elder group.Gender,age,anterior wall myocardial infarction,systolic blood pressure,diastolic blood pressure,Killip classification≥III,and ACEI / ARB were statistically significant.Female(OR=2.097;95%CI:1.020-4.312,P=0.044)was the independent risk factor for in-hospital mortality in PCI elderly group.Conclusions:1.Without adjusting the risk factors,the in-hospital mortality rate of female in STEMI is higher than that of men,which is not affected by PCI or age classification.With adjusting the risk factors,woman is the independent risk factor of in-hospital mortality after PCI,and the mortality of female is about 2.097 times of male.2.Age,anterior myocardial infarction and Killip classification ≥ III are communal independent risk factors of in-hospital mortality of each group of STEMI patients which is not affected by PCI and age classification.3.Statins and β-blockers reduce the postoperative mortality of young STEMI patients after PCI.ACEI / ARB reduces the postoperative mortality of elder STEMI patients after PCI.