Hochman J S, Tamis J E, Thompson T D, Weaver W D, White H D, Van de Werf F, Aylward P, Topol E J, Califf R M
St. Luke's-Roosevelt Hospital Center and Columbia University, New York, NY 10025, USA.
N Engl J Med. 1999 Jul 22;341(4):226-32. doi: 10.1056/NEJM199907223410402.
Studies have reported that women with acute myocardial infarction have in-hospital and long-term outcomes that are worse than those of men.
To assess sex-based differences in presentation and outcome, we examined data from the Global Use of Strategies to Open Occluded Coronary Arteries in Acute Coronary Syndromes IIb study, which enrolled 12,142 patients (3662 women and 8480 men) with acute coronary syndromes, including infarction with ST-segment elevation, infarction with no ST-segment elevation, and unstable angina.
Overall, the women were older than the men, and had significantly higher rates of diabetes, hypertension, and prior congestive heart failure. They had significantly lower rates of prior myocardial infarction and were less likely ever to have smoked. A smaller percentage of women than men had infarction with ST elevation (27.2 percent vs. 37.0 percent, P<0.001), and of the patients who presented with no ST elevation (those with myocardial infarction or unstable angina), fewer women than men had myocardial infarction (36.6 percent vs. 47.6 percent, P<0.001). Women had more complications than men during hospitalization and a higher mortality rate at 30 days (6.0 percent vs. 4.0 percent, P<0.001) but had similar rates of reinfarction at 30 days after presentation. However, there was a significant interaction between sex and the type of coronary syndrome at presentation (P=0.001). After stratification according to coronary syndrome and adjustment for base-line variables, there was a nonsignificant trend toward an increased risk of death or reinfarction among women as compared with men only in the group with infarction and ST elevation (odds ratio, 1.27; 95 percent confidence interval, 0.98 to 1.63; P=0.07). Among patients with unstable angina, female sex was associated with an independent protective effect (odds ratio for infarction or death, 0.65; 95 percent confidence interval, 0.49 to 0.87; P=0.003).
Women and men with acute coronary syndromes had different clinical profiles, presentation, and outcomes. These differences could not be entirely accounted for by differences in base-line characteristics and may reflect pathophysiologic and anatomical differences between men and women.
研究报告称，急性心肌梗死女性患者的院内及长期预后比男性患者差。
为评估急性冠脉综合征患者在临床表现及预后方面的性别差异，我们分析了全球急性冠脉综合征IIb期开放闭塞冠状动脉策略应用研究的数据，该研究纳入了12142例急性冠脉综合征患者（3662例女性和8480例男性），包括ST段抬高型心肌梗死、非ST段抬高型心肌梗死和不稳定型心绞痛患者。
总体而言，女性患者年龄大于男性，糖尿病、高血压及既往充血性心力衰竭发生率显著更高。她们既往心肌梗死发生率显著更低，且吸烟可能性更小。ST段抬高型心肌梗死女性患者比例低于男性（27.2%对37.0%，P<0.001），在非ST段抬高型患者（心肌梗死或不稳定型心绞痛患者）中，心肌梗死女性患者少于男性（36.6%对47.6%，P<0.001）。女性住院期间并发症多于男性，30天死亡率更高（6.0%对4.0%，P<0.001），但发病后30天再梗死发生率相似。然而，性别与急性冠脉综合征类型之间存在显著交互作用（P=0.001）。根据急性冠脉综合征分层并对基线变量进行校正后，仅在ST段抬高型心肌梗死组中，女性死亡或再梗死风险有升高趋势，但无统计学意义（比值比，1.27；95%置信区间，0.98至1.63；P=0.07）。在不稳定型心绞痛患者中，女性具有独立的保护作用（心肌梗死或死亡的比值比，0.65；95%置信区间，0.49至0.87；P=0.003）。
急性冠脉综合征女性和男性患者具有不同的临床特征、临床表现及预后。这些差异不能完全由基线特征差异解释，可能反映了男女之间的病理生理及解剖学差异。
