Background Although previous studies using Korean data have already reported higher rates of mortality in women, it is less clear whether these gender differences in prognosis post ST-segment elevation myocardial infa...Background Although previous studies using Korean data have already reported higher rates of mortality in women, it is less clear whether these gender differences in prognosis post ST-segment elevation myocardial infarction （STEMI）, are age dependent. The aim of this study is to examine the gender-age interaction with early and late mortality in patients with STEMI enrolled in the Korean nationwide regis-try. Methods This prospective study stratified outcomes according to gender and age from 17,021 STEMI patients. We compared in-hospital, early （30 days） and late （12 months） mortality between gender to examine the gender-age interaction in multivariable models. Results In younger women （〈 60 years）, in-hospital [5.8% vs. 2.5%, P 〈 0.001; unadjusted odds ratios （OR）： 2.41, 95% confidence inter-vals （CI）： 1.59-3.66], early （6.2% vs. 2.6%, P 〈 0.001; unadjusted OR： 2.4, 95% CI： 2.12-2.72） and late mortality （7.0% vs. 3.1%, P 〉 0.001; unadjusted OR： 2.33, 95% CI： 2.08-2.61） were significantly higher compared with men. However, after adjustment for patient characteristics, Killip class ≥ 3, symptom to balloon time and major bleeding, and in-hospital bleeding, overall early and late mortality were no longer re-lated to gender in any age groups. Conclusions Among a Korean population with STEMI, higher early and late mortality in younger women may be explained by poor patient characteristics, higher Killip class ≥3, longer symptom to balloon time and more frequent major bleeding. Therefore, based on gender-age differences, more precise and aggressive preventive strategies focused on risk factor reduction, education and more intensive management for yotmger women should be performed.展开更多
Background Studies have shown that staged percutaneous coronary intervention （PCI） for non-culprit lesions is beneficial for prog- nosis of ST-segment elevation myocardial infarction （STEMI） patients with multives...Background Studies have shown that staged percutaneous coronary intervention （PCI） for non-culprit lesions is beneficial for prog- nosis of ST-segment elevation myocardial infarction （STEMI） patients with multivessel disease. However, the optimal timing of staged re- vascularization is still controversial. This study aimed to find the optimal timing of staged revascularization. Methods A total of 428 STEMI patients with multivessel disease who underwent primary PCI and staged PCI were included. According to the time interval between primary and staged PCI, patients were divided into three groups （〈 1 week, 1- weeks, and 2-12 weeks after primary PCI）. The primary endpoint was major adverse cardiovascular events （MACE）, a composite of all-cause death, non-fatal re-infarction, repeat revascularization, and stroke. Cox regression model was used to assess the association between staged PCI timing and risk of MACE. Results During the follow-up, 119 participants had MACEs. There was statistical difference in MACE incidence among the three groups （〈 1 week： 23.0%; 1-2 weeks： 33.0%; 2-12 weeks： 40.0%; P = 0.001）. In the multivariable adjustment model, the timing interval of staged PCI ≤ 1 week and l-2 weeks were both significantly associated with a lower risk of MACE [hazard ratio （HR）： 0.40, 95% confidence intervals （CI）： 0.24-4）.65; HR： 0.54, 95% CI： 0.3 lq3.93, respectively], mainly attributed to a lower risk of repeat revascularization （HR： 0.41, 95% CI： 0.24-0.70; HR： 0.36, 95% CI： 0.18-0.7）, compared with a strategy of 2-12 weeks later of primary PCI. Conclusions The optimal timing of staged PCI for non-culprit vessels should be within two weeks after primary PCI for STEMI patients.展开更多
Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI...Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.展开更多
文摘Background Although previous studies using Korean data have already reported higher rates of mortality in women, it is less clear whether these gender differences in prognosis post ST-segment elevation myocardial infarction （STEMI）, are age dependent. The aim of this study is to examine the gender-age interaction with early and late mortality in patients with STEMI enrolled in the Korean nationwide regis-try. Methods This prospective study stratified outcomes according to gender and age from 17,021 STEMI patients. We compared in-hospital, early （30 days） and late （12 months） mortality between gender to examine the gender-age interaction in multivariable models. Results In younger women （〈 60 years）, in-hospital [5.8% vs. 2.5%, P 〈 0.001; unadjusted odds ratios （OR）： 2.41, 95% confidence inter-vals （CI）： 1.59-3.66], early （6.2% vs. 2.6%, P 〈 0.001; unadjusted OR： 2.4, 95% CI： 2.12-2.72） and late mortality （7.0% vs. 3.1%, P 〉 0.001; unadjusted OR： 2.33, 95% CI： 2.08-2.61） were significantly higher compared with men. However, after adjustment for patient characteristics, Killip class ≥ 3, symptom to balloon time and major bleeding, and in-hospital bleeding, overall early and late mortality were no longer re-lated to gender in any age groups. Conclusions Among a Korean population with STEMI, higher early and late mortality in younger women may be explained by poor patient characteristics, higher Killip class ≥3, longer symptom to balloon time and more frequent major bleeding. Therefore, based on gender-age differences, more precise and aggressive preventive strategies focused on risk factor reduction, education and more intensive management for yotmger women should be performed.
文摘Background Studies have shown that staged percutaneous coronary intervention （PCI） for non-culprit lesions is beneficial for prog- nosis of ST-segment elevation myocardial infarction （STEMI） patients with multivessel disease. However, the optimal timing of staged re- vascularization is still controversial. This study aimed to find the optimal timing of staged revascularization. Methods A total of 428 STEMI patients with multivessel disease who underwent primary PCI and staged PCI were included. According to the time interval between primary and staged PCI, patients were divided into three groups （〈 1 week, 1- weeks, and 2-12 weeks after primary PCI）. The primary endpoint was major adverse cardiovascular events （MACE）, a composite of all-cause death, non-fatal re-infarction, repeat revascularization, and stroke. Cox regression model was used to assess the association between staged PCI timing and risk of MACE. Results During the follow-up, 119 participants had MACEs. There was statistical difference in MACE incidence among the three groups （〈 1 week： 23.0%; 1-2 weeks： 33.0%; 2-12 weeks： 40.0%; P = 0.001）. In the multivariable adjustment model, the timing interval of staged PCI ≤ 1 week and l-2 weeks were both significantly associated with a lower risk of MACE [hazard ratio （HR）： 0.40, 95% confidence intervals （CI）： 0.24-4）.65; HR： 0.54, 95% CI： 0.3 lq3.93, respectively], mainly attributed to a lower risk of repeat revascularization （HR： 0.41, 95% CI： 0.24-0.70; HR： 0.36, 95% CI： 0.18-0.7）, compared with a strategy of 2-12 weeks later of primary PCI. Conclusions The optimal timing of staged PCI for non-culprit vessels should be within two weeks after primary PCI for STEMI patients.
文摘Objective To investigate whether admission time was associated with the delay of reperfusion therapy and in-hospital death in patients with ST-elevation myocardial infarction （STEMI）. Methods All patients with STEMI who were admitted to the emergency depart- ment and underwent primary percutaneous coronary intervention at Peking University People＇s Hospital between April 2012 and March 2015 were included. We examined differences in clinical characteristics, total ischemic time, and in-hospital death between patients admitted during off-hours and those admitted during regular hours. Multivariate logistic regression was used to estimate the relationship between off-hours admission and clinical outcome. Results The sample comprised 184 and 105 patients with STEMI admitted to hospital during off-hours and regular hours, respectively. Total ischemic and onset-to-door times were significantly shorter in patients admitted during off-hours than among those admitted during regular hours （all P 〈 0.05）. Door-to-balloon （DTB） time, the rate of DTB time 〈 90 min, and in-hospital death were comparable between groups. Multivariate logistic regression showed that age and creatinine level, but not off-hours admission, were associated independently with increased in-hospital death. Conclusions Off-hours admission did not result in delayed reperfusion therapy or increased in-hospital mortality in patients with STEMI. Further efforts should focus on identifying pivotal factors associated with the pre-hospital and in-hospital delay of reperfusion therapy, and implementing quality improvement initiatives for reperfusion programs.
