Gender difference in the prognostic value of renal dysfunction in patients with ST-segment elevation myocardial infarction / 中华内科杂志

ABSTRACT

Objective To evaluate the gender difference in the prognostic value of admission renal dysfunction (RD) for patients with acute ST-segment elevation (STEMI).Methods This was a multicenter,prospective cohort study.Four hundred and fifty STEMI patients within 24 h of onset and discharged successfully from 19 hospitals in Beijing were included in the study.All the patients were followed up six years later.According to gender,patients were categorized into two groups.Clinical characteristics,reperfusion therapy conditions and outcomes were analyzed.Multivariate Cox regression analysis was used to evaluate the possible gender difference in the prognostic value of RD.Results Among all the subjects,342 were men and 108 were women with age of (61.3 ± 12.5) years.Compared to man patients,women were older (P ＜ 0.001),and more subjects were with hypertension (67.6％ vs 49.7 ％,P =0.005),stroke (15.7％ vs 8.8％,P =0.039) and RD (17.9％ vs 6.7％,P =0.001).After adjustment of age,past medical history,and acute reperfusion therapy.Cox regression analysis showed that RD was associated with the risk of all-cause mortality (HR 3.771,95％ CI 1.382-10.294,P =0.010) and major adverse cardiovascular events (MACE,HR 2.292,95％ CI1.091-4.817,P =0.029) in male patients.However,the associations between RD and all-cause mortality(HR 0.889,95％ CI 0.241-3.281,P =0.859),and MACE(HR 1.508,95％ CI 0.616-3.693,P =0.368)were disappeared in women.The interaction test showed that there existed significant interactions between gender and RD in all-cause mortality(HR 2.709,95％CI 1.150-6.384,P =0.023)and MACE(HR 1.977,95％ CI 1.009-3.876,P =0.023).Conclusions There is a considerable gender difference in the prognostic value of RD for the outcomes in patients with STEMI.RD seemed to be an important prognostic maker in male patients.