Gottlieb S, Goldbourt U, Boyko V, Harpaz D, Mandelzweig L, Khoury Z, Stern S, Behar S
The Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel.
Eur Heart J. 2000 Feb;21(4):284-95. doi: 10.1053/euhj.1999.1868.
To assess trends in the management and subsequent outcome in men and women in two cohorts of consecutive patients with acute myocardial infarction hospitalized in coronary care units in Israel, in the pre-reperfusion and the reperfusion eras.
We compared trends in the in-hospital management, and 30-day and 1-year mortality in men and women in two cohorts of patients hospitalized with acute myocardial infarction in coronary care units in Israel, in the pre-reperfusion and the reperfusion eras. The first cohort of 5839 consecutive patients (4315 men, 74%) was from the Secondary Prevention Reinfarction Israeli Nifedipine Trial (SPRINT) registry of 1981-1983; the second cohort of 1940 patients (1429 males, 74%) derived from two prospective nationwide surveys conducted in all coronary care units in Israel in January/February 1992 and 1994. The demographic and clinical characteristics of patients with acute myocardial infarction in both periods were comparable. Patients in 1992-94 received aspirin, angiotensin-converting enzyme inhibitors, beta-blockers and nitrates more frequently than in 1981-83. Thrombolysis, coronary angiography, angioplasty and bypass grafting were not used in 1981-83, whereas in 1992-94 these procedures were used in 45%, 28%, 11% and 4% of men, respectively, and in 39%, 20%, 9% and 3% of women, respectively. The 30-day age-adjusted mortality declined, in men, from 17.0% in 1981-83 to 10.8% in 1992-94 (multivariate-adjusted odds ratio [OR]=0. 69; 95% confidence interval [CI] 0.55 to 0.87), and the cumulative 1-year age-adjusted mortality declined from 24.6% to 16.9% (adjusted hazard ratio [HR]=0.70%; 95% CI 0.60 to 0.81). In women, the decline in mortality rates were of similar magnitude, from 24.0% to 15.1% (OR=0.70; 95% CI 0.52 to 0.94), and from 33.6% to 21.0% (HR=0.67; 95% CI 0.55 to 0.81), respectively. In both sexes, the decline in mortality was more marked in patients reperfused by thrombolysis and/or mechanical revascularization, but was also evident in non-reperfused patients.
Despite higher mortality in both periods in women compared to men, the prognosis of men and women with acute myocardial infarction improved considerably during the last decade, with a similar decline in 1-year mortality of approximately 30%. The implementation in daily practice of new therapeutic modalities proven to be effective in clinical trials after acute myocardial infarction, probably played a major role in this favourable outcome in both sexes.
评估在以色列冠心病监护病房住院的两个连续急性心肌梗死患者队列中，男性和女性在再灌注时代之前和再灌注时代的管理趋势及后续结局。
我们比较了以色列冠心病监护病房收治的两个急性心肌梗死患者队列中男性和女性的院内管理趋势、30天和1年死亡率，这两个队列分别处于再灌注时代之前和再灌注时代。第一个队列由1981 - 1983年以色列硝苯地平二级预防再梗死试验（SPRINT）登记的5839例连续患者组成（4315例男性，占74%）；第二个队列由1992年1月/2月和1994年在以色列所有冠心病监护病房进行的两项全国性前瞻性调查中的1940例患者组成（1429例男性，占74%）。两个时期急性心肌梗死患者的人口统计学和临床特征具有可比性。1992 - 1994年的患者比1981 - 1983年的患者更频繁地使用阿司匹林、血管紧张素转换酶抑制剂、β受体阻滞剂和硝酸盐。1981 - 1983年未使用溶栓、冠状动脉造影、血管成形术和搭桥手术，而在1992 - 1994年，这些手术在男性中的使用率分别为45%、28%、11%和4%，在女性中的使用率分别为39%、20%、9%和3%。30天年龄调整死亡率在男性中从1981 - 1983年的17.0%降至1992 - 1994年的10.8%（多变量调整优势比[OR]=0.69；95%置信区间[CI]0.55至0.87），累积1年年龄调整死亡率从24.6%降至16.9%（调整风险比[HR]=0.70%；95%CI0.60至0.81）。在女性中，死亡率下降幅度相似，分别从24.0%降至15.1%（OR=0.70；95%CI0.52至0.94），从33.6%降至21.0%（HR=0.67；95%CI0.55至0.81）。在两性中，溶栓和/或机械再灌注患者的死亡率下降更为明显，但在未再灌注患者中也很明显。
尽管在两个时期女性的死亡率均高于男性，但在过去十年中，急性心肌梗死男性和女性的预后有了显著改善，1年死亡率下降幅度相似，约为30%。在急性心肌梗死后临床试验中被证明有效的新治疗方法在日常实践中的应用，可能在两性的这一良好结局中起了主要作用。
