The contribution of gender and age on early and late mortality following ST-segment elevation myocardial infarction: results from the Korean Acute Myocardial Infarction National Registry with Registries

초록

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 registry. 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 intervals (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 related 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 younger women should be performed.

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