接受再灌注治疗的ST段抬高型心肌梗死患者死亡率性别差异的荟萃分析

Gender differences in mortality of ST-segment elevation myocardial infarction patients receiving reperfusion therapy:a meta-analysis

目的 探讨接受再灌注治疗的ST段抬高型心肌梗死(STEMI)患者死亡率的性别差异。方法 全面检索PubMed、EMBASE、万方数据库、中国知网和谷歌学术等数据库自建库至2023年8月1日的文献中,对接受溶栓治疗或直接经皮冠状动脉介入术(PPCI)的STEMI患者短期或长期死亡率的性别差异进行对比的相关研究。观察性研究和随机对照研究均纳入本研究。使用Rev Man 5软件进行统计学分析。使用危险度(RR)和95%CI表示性别差异对STEMI患者死亡率的影响。使用漏斗图评估研究偏倚。结果 共纳入36项研究,其中33项观察性研究和3项随机对照研究,共108 132例STEMI患者,其中男性82 848例,女性25 284例。与男性患者相比,女性患者住院期间(RR=1.73,95%CI:1.52~1.98,P<0.001,I~2=69%)、1个月(RR=1.89,95%CI:1.74~2.06,P<0.001,I~2=46%)、1年(RR=1.56,95%CI:1.40~1.74,P<0.001,I~2=0%)和2年(RR=1.78,95%CI:1.51~2.10,P<0.001,I~2=43%)死亡率显著增加。在调整后的分析中,女性STEMI患者住院期间(RR=1.60,95%CI:1.27~2.02,P<0.001,I~2=69%)、1个月(RR=1.40,95%CI:1.04~1.88,P<0.001,I~2=65%)和2年(RR=1.25,95%CI:1.10~1.42,P<0.001,I~2=48%)死亡率仍明显高于男性患者。结论 对于接受再灌注治疗的STEMI患者,女性的短期和长期死亡率均高于男性。

Objective To investigate the gender differences in mortality of ST-segment elevation myocardial infarction(STEMI)patients receiving reperfusion therapy.Methods A comprehensive search was conducted on the literature from PubMed,EMBASE,Wanfang database,CNKI,and Google Academic databases established until August 1,2023,to compare the gender differences in short-term or long-term mortality rates of STEMI patients receiving thrombolysis or primary percutaneous coronary intervention(PPCI)treatment.Both observational studies and randomized controlled studies were included.Rev Man5 software was used for statistical analysis,and the risk ratio(RR)as well as 95%confidence interval(CI)were used to represent the impact of gender differences on the mortality of STEMI.A funnel plot was employed to assess research bias.Results The analysis included 36 studies(33 observational studies and 3 randomized controlled studies),including 82848 male and 25284 female STEMI patients.Compared to males,female STEMI patients demonstrated significant increases of in-hospital mortality(RR=1.73,95%CI:1.52-1.98,P<0.001,I~2=69%),1-month mortality(RR=1.89,95%CI:1.74-2.06,P<0.001,I~2=46%),1-year mortality(RR=1.56,95%CI:1.40-1.74,P<0.001,I~2=0%)and 2-year mortality(RR=1.78,95%CI:1.51-2.10,P<0.001,I~2=43%).In the adjusted analysis,the mortality rates of female STEMI patients during in-hospital(RR=1.60,95%CI:1.27-2.02,P<0.001,I~2=69%),1-month(RR=1.40,95%CI:1.04-1.88,P<0.001,I~2=65%)and 2-year(RR=1.25,95%CI:1.10-1.42,P<0.001,I~2=48%)were still significantly higher than those of male patients.Conclusions Female STEMI patients receiving reperfusion therapy experience higher short-term and long-term mortality rates compared to male patients.compared to male patients.