医学
内科学
心肌梗塞
经皮冠状动脉介入治疗
心脏病学
死因
冲程(发动机)
血运重建
血栓
心力衰竭
疾病
机械工程
工程类
作者
Maria Virginia Manzi,Sergio Buccheri,Sanjit S. Jolly,Felix Zijlstra,Ole Fröbert,Bo Lagerqvist,Karim Mahmoud,Vladimir Dzavik,Emanuele Barbato,Giovanna Sarno,Stefan James
标识
DOI:10.1016/j.jcin.2022.08.013
摘要
Women have a worse prognosis after ST-segment elevation myocardial infarction (STEMI) than men. The prognostic role of thrombus burden (TB) in influencing the sex-related differences in clinical outcomes after STEMI has not been clearly investigated.The aim of this study was to assess the sex-related differences in TB and its clinical implications in patients with STEMI.Individual patient data from the 3 major randomized clinical trials of manual thrombus aspiration were analyzed, encompassing a total of 19,047 patients with STEMI, of whom 13,885 (76.1%) were men and 4,371 (23.9%) were women. The primary outcome of interest was 1-year cardiovascular (CV) death. The secondary outcomes of interest were recurrent myocardial infarction, heart failure, all-cause mortality, stroke, stent thrombosis (ST), and target vessel revascularization at 1 year.Patients with high TB (HTB) had worse 1-year outcomes compared with those presenting with low TB (adjusted HR for CV death: 1.52; 95% CI: 1.10-2.12; P = 0.01). In unadjusted analyses, female sex was associated with an increased risk for 1-year CV death regardless of TB. After adjustment, the risk for 1-year CV death was higher only in women with HTB (HR: 1.23; 95% CI: 1.18-1.28; P < 0.001), who also had an increased risk for all-cause death and ST than men.In patients with STEMI, angiographic evidence of HTB negatively affected prognosis. Among patients with HTB, women had an excess risk for ST, CV, and all-cause mortality than men. Further investigations are warranted to better understand the pathophysiological mechanisms leading to excess mortality in women with STEMI and HTB.
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