Sex differences in trends and in-hospital outcomes of acute myocardial infarction in patients with familial hypercholesterolemia: insights from a large national database

Sex differences in clinical outcomes following acute myocardial infarction (AMI) are well known. However, data on sex differences among patients with familial hypercholesterolemia (FH) are limited. We aimed to explore sex differences in outcomes of AMI among patients with FH from a national administrative dataset. We utilized the National Inpatient Sample to identify admissions with a primary diagnosis of AMI and a secondary diagnosis of FH. Our primary outcome of interest was in-hospital mortality; secondary outcomes were performance of percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG), respiratory complications, use of inotropes, use of mechanical circulatory support (MCS), bleeding complications, transfusion and facility discharge. We adjusted for demographics (model A), comorbidities (model B), and intervention (model C). Between October 2016 and December 2020, 5,714,993 admissions with a primary diagnosis of AMI were identified, of which 3,035 (0.05%) had a secondary diagnosis of FH. In-hospital mortality did not differ between men and women (Model C, adjusted OR = 0.85; 95% CI 0.28–2.60, p = 0.773). There was no sex difference in the secondary outcomes. Despite generally being older and having more comorbidities, women with FH fair equally with men with FH in terms of mortality during AMI admission.急性心肌梗死（acute myocardial infarction, AMI）后临床结局的性别差异已得到广泛证实。然而，家族性高胆固醇血症（familial hypercholesterolemia, FH）患者群体中的性别差异相关数据仍较为有限。本研究旨在利用全国行政数据集，探究家族性高胆固醇血症患者群体中急性心肌梗死患者的结局性别差异。我们采用全国住院患者样本（National Inpatient Sample），筛选出以急性心肌梗死为主要诊断、家族性高胆固醇血症为次要诊断的住院病例。本研究的主要结局指标为住院期间死亡率；次要结局指标包括经皮冠状动脉介入治疗（percutaneous coronary intervention, PCI）、冠状动脉旁路移植术（coronary artery bypass grafting, CABG）的实施情况，呼吸系统并发症发生率，正性肌力药物使用情况，机械循环支持（mechanical circulatory support, MCS）使用情况，出血并发症发生率，输血情况以及医疗机构出院结局。我们分别针对人口统计学特征（模型A）、合并症情况（模型B）以及干预措施（模型C）进行了校正。在2016年10月至2020年12月期间，共筛选出5,714,993例以急性心肌梗死为主要诊断的住院病例，其中3,035例（占比0.05%）合并家族性高胆固醇血症次要诊断。经模型C校正后，男女患者的住院死亡率无显著差异（校正后比值比OR=0.85；95%置信区间CI：0.28~2.60，P=0.773）。次要结局指标亦未发现显著性别差异。尽管FH女性患者普遍年龄更高、合并症更多，但在急性心肌梗死住院期间的死亡率方面，与男性患者并无显著差异。