目的：了解我国二级医院急性ST段抬高型心肌梗死（STEMI）患者住院死亡率的性别差异及其影响因素。方法：2011-09到2014-06期间在全国15个省或自治区99家二级医院收录共计5525例因STEMI住院的患者，其中男性3876例，女性1649例。比较住院死亡率的性别差异，使用多因素Logistic回归分析差异的相关因素。结果：所有研究对象中，女性占29.8%，男性占70.2%。住院死亡率在女性与男性中分别为13.2%和5.9%， P<0.01。该性别差异无论年龄高低、是否既往有心肌梗死、高血压、糖尿病均显著存在，在不具备任何疾病史和心血管危险因素的患者中，女性死亡率仍大于男性。与男性相比，女性患病时的平均年龄偏大，且更易合并心血管危险因素，入院后10 min 内心电图检查、药物治疗及溶栓比例低于男性，但经过多因素分析调整混杂因素后女性死亡率仍显著大于男性[比值比（OR ）：1.7，95%可信区间（CI ）：1.4~2.0]。结论：我国二级医院STEMI患者住院死亡率在女性患者中显著高于男性患者。和男性相比，女性患者具备以下特点：发病平均年龄较大，合并心血管风险因素更多，且入院后10 min内心电图检查、药物治疗以及溶栓治疗力度不足。%Objective: To understand the gender disparity and influencing factors for in-hospital mortality in patients with ST-segment elevation myocardial infarction (STEMI) at secondary hospitals in China. Methods: A total of 5525 in-hospital STEMI patients from 99 secondary hospitals of 15 provinces or autonomous regions between 2011-09 to 2014-06 were recruited including 1649 female and 3876 male. The in-hospital mortalities were compared between 2 genders and the relevant inlfuencing factors were studied by multiple Logistic regression analysis. Results: There were about 29.8% female and 70.2% male STEMI patients were studied. The in-hospital mortalities in female and male were 13.2% and 5.9%,P<0.01; gender disparity was obviously existing regardless of age, history of MI, hypertension and diabetes mellitus. The mortality in female was higher than male even without diseases history and cardiovascular risk factors. Compared with male gender, female patients were usually having elder age and likely complicated with cardiovascular risk factors; they were with lower incidence to receive ECG, drug therapy and thrombolysis within 10 minutes of admission. With adjusted confounding factors, multiple regression analysis presented that female STEMI patients had the higher mortality than male (OR:1.7, 95% CI:1.4-2.0). Conclusion: The in-hospital mortality for STEMI patients was higher in female than male at secondary hospitals in China. Female patients were usually having elder age, complicated with more cardiovascular risk factors, while with less chances to receive ECG, drug therapy and thrombolysis within 10 minutes of admission.
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