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Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis

OBJECTIVES: To assess the effect of sex differences on short-term and long-term mortality among patients with ST-segment elevation myocardial infarction (STEMI). DESIGN: Systematic review and meta-analysis of contemporary available evidence. SETTING: PubMed, Embase and Cochrane Library were searched...

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Autores principales: Xi, Ziwei, Qiu, Hong, Guo, Tingting, Wang, Yong, Li, Jianan, Li, Yang, Zheng, Jianfeng, Gao, R
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Publishing Group 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8915368/
https://www.ncbi.nlm.nih.gov/pubmed/35264344
http://dx.doi.org/10.1136/bmjopen-2021-053379
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author Xi, Ziwei
Qiu, Hong
Guo, Tingting
Wang, Yong
Li, Jianan
Li, Yang
Zheng, Jianfeng
Gao, R
author_facet Xi, Ziwei
Qiu, Hong
Guo, Tingting
Wang, Yong
Li, Jianan
Li, Yang
Zheng, Jianfeng
Gao, R
author_sort Xi, Ziwei
collection PubMed
description OBJECTIVES: To assess the effect of sex differences on short-term and long-term mortality among patients with ST-segment elevation myocardial infarction (STEMI). DESIGN: Systematic review and meta-analysis of contemporary available evidence. SETTING: PubMed, Embase and Cochrane Library were searched for relevant studies reporting sex-specific outcomes among patients with STEMI published between 1 January 2010 and 1 August 2020. Risk ratios (RRs) and 95% CIs were measured using DerSimonian and Laird random-effects model. Sensitivity analyses were performed and publication bias was also checked. All statistical analyses were performed using STATA V.15.0. PARTICIPANTS: Studies providing data about short-term or long-term mortality stratified by sex in patients with STEMI were included. Only study conducted in last 10 years were included. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was all-cause death at short-term (in-hospital or 30 days) and long-term (at least 12 months) follow-up. RESULTS: A total of 15 studies involving 128 585 patients (31 706 (24.7%) female and 96 879 (75.3%) male) were included. In the unadjusted analyses, female were at a higher risk of short-term mortality (RR, 1.73; 95% CI 1.53 to 1.96, p<0.001, I(2)=77%) but not long-term mortality (RR, 1.23; 95% CI 0.89 to 1.69, p=0.206, I(2)=77.5%). When adjusted effect estimates from individual studies were used in meta-analysis, the association between female and higher risk of short-term mortality remained significant (RR, 1.24; 95% CI 1.11 to 1.38, p<0.001, I(2)=39.6%). And adjusted long-term mortality was also similar between female and male (RR, 1.11; 95% CI 0.42 to 1.80, p=0.670, I(2)=74.5%). CONCLUSIONS: An increased short-term but not long-term mortality was found in female with STEMI. After adjustment for baseline cardiovascular risk factors and clinical profiles, short-term mortality remains higher in female with STEMI compared with male, indicating the need for further improvements in management in female patients.
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spelling pubmed-89153682022-03-25 Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis Xi, Ziwei Qiu, Hong Guo, Tingting Wang, Yong Li, Jianan Li, Yang Zheng, Jianfeng Gao, R BMJ Open Epidemiology OBJECTIVES: To assess the effect of sex differences on short-term and long-term mortality among patients with ST-segment elevation myocardial infarction (STEMI). DESIGN: Systematic review and meta-analysis of contemporary available evidence. SETTING: PubMed, Embase and Cochrane Library were searched for relevant studies reporting sex-specific outcomes among patients with STEMI published between 1 January 2010 and 1 August 2020. Risk ratios (RRs) and 95% CIs were measured using DerSimonian and Laird random-effects model. Sensitivity analyses were performed and publication bias was also checked. All statistical analyses were performed using STATA V.15.0. PARTICIPANTS: Studies providing data about short-term or long-term mortality stratified by sex in patients with STEMI were included. Only study conducted in last 10 years were included. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was all-cause death at short-term (in-hospital or 30 days) and long-term (at least 12 months) follow-up. RESULTS: A total of 15 studies involving 128 585 patients (31 706 (24.7%) female and 96 879 (75.3%) male) were included. In the unadjusted analyses, female were at a higher risk of short-term mortality (RR, 1.73; 95% CI 1.53 to 1.96, p<0.001, I(2)=77%) but not long-term mortality (RR, 1.23; 95% CI 0.89 to 1.69, p=0.206, I(2)=77.5%). When adjusted effect estimates from individual studies were used in meta-analysis, the association between female and higher risk of short-term mortality remained significant (RR, 1.24; 95% CI 1.11 to 1.38, p<0.001, I(2)=39.6%). And adjusted long-term mortality was also similar between female and male (RR, 1.11; 95% CI 0.42 to 1.80, p=0.670, I(2)=74.5%). CONCLUSIONS: An increased short-term but not long-term mortality was found in female with STEMI. After adjustment for baseline cardiovascular risk factors and clinical profiles, short-term mortality remains higher in female with STEMI compared with male, indicating the need for further improvements in management in female patients. BMJ Publishing Group 2022-03-09 /pmc/articles/PMC8915368/ /pubmed/35264344 http://dx.doi.org/10.1136/bmjopen-2021-053379 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) .
spellingShingle Epidemiology
Xi, Ziwei
Qiu, Hong
Guo, Tingting
Wang, Yong
Li, Jianan
Li, Yang
Zheng, Jianfeng
Gao, R
Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis
title Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis
title_full Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis
title_fullStr Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis
title_full_unstemmed Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis
title_short Contemporary sex differences in mortality among patients with ST-segment elevation myocardial infarction: a systematic review and meta-analysis
title_sort contemporary sex differences in mortality among patients with st-segment elevation myocardial infarction: a systematic review and meta-analysis
topic Epidemiology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8915368/
https://www.ncbi.nlm.nih.gov/pubmed/35264344
http://dx.doi.org/10.1136/bmjopen-2021-053379
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