Hanratty B, Lawlor D A, Robinson M B, Sapsford R J, Greenwood D, Hall A
Department of Public Health, University of Liverpool, Whelan Building, Quadrangle, Liverpool L69 3GB.
J Epidemiol Community Health. 2000 Dec;54(12):912-6. doi: 10.1136/jech.54.12.912.
Coronary heart disease is the major cause of death of postmenopausal women in industrialised countries. Although acute myocardial infarction (AMI) affects men in greater numbers, the short-term outcomes for women are worse. In the longer term, studies suggest that mortality risk for women is lower or similar to that of men. However, length of follow up and adjustment for confounding factors have varied and more importantly, the association between treatment and outcomes has not been examined.
To investigate the association between sex differences in risk factors and hospital treatment and mortality after AMI.
A prospective observational study collecting demographic and clinical data on cases of AMI admitted to hospitals in Yorkshire. The main outcome measures were mortality status at discharge from hospital and two years later.
All district and university hospitals accepting emergency admissions in the former Yorkshire National Health Service (NHS) region of northern England.
3684 consecutive patients with a possible diagnosis of AMI admitted to hospitals in Yorkshire between 1 September and 30 November 1995.
AMI was confirmed by the attending consultant for 2196 admissions (2153 people, 850 women and 1303 men). Women were older and less likely than men to be smokers or have a history of ischaemic heart disease. Crude inhospital mortality was higher for women (30% versus 19% for men, crude odds ratio of death before discharge for women 1.78, 95% confidence intervals 1.46, 2.18, p=0.00). This difference persisted after adjustment for age, risk factors and comorbidities (adjusted OR 1.29, 95% CI 1.04, 1.63, p=0.02), but was not significant when treatment was taken into account. Women were less likely to be given thrombolysis (37% versus 46%, p<0.01) and aspirin (83% versus 90%, p<0.01), discharged with beta blockers (33% versus 47%, p<0.01) and aspirin (82% versus 88% p<0.01) or be scheduled for angiography, exercise testing or revascularisation. Adjustment for age removed much of the disparity in treatment. Crude mortality rate at two years was higher for women (OR 1.81, 95%CI 1.41, 2.31, p=0.00). Age, existing risk factors and acute treatment accounted for most of this difference, with treatment on discharge having little additional influence.
Patients admitted to hospital with AMI should be offered optimal treatment irrespective of age or sex. Women have a worse prognosis after AMI and under-treatment of older people with aspirin and thrombolysis may be contributing to this.
在工业化国家，冠心病是绝经后女性的主要死因。虽然急性心肌梗死（AMI）在男性中更为常见，但女性的短期预后更差。从长期来看，研究表明女性的死亡风险较低或与男性相似。然而，随访时间和混杂因素的调整各不相同，更重要的是，治疗与预后之间的关联尚未得到研究。
探讨AMI后危险因素和医院治疗方面的性别差异与死亡率之间的关联。
一项前瞻性观察性研究，收集了约克郡医院收治的AMI病例的人口统计学和临床数据。主要结局指标是出院时和两年后的死亡状况。
英格兰北部原约克郡国民健康服务（NHS）地区所有接受急诊入院的地区医院和大学医院。
1995年9月1日至11月30日期间，约克郡医院连续收治的3684例可能诊断为AMI的患者。
主治顾问确认2196例入院患者（2153人，850名女性和1303名男性）为AMI。女性年龄较大，吸烟或有缺血性心脏病史的可能性低于男性。女性的住院粗死亡率较高（30%，男性为19%，女性出院前死亡的粗比值比为1.78，95%置信区间为1.46，2.18，p = 0.00）。在调整年龄、危险因素和合并症后，这种差异仍然存在（调整后的比值比为1.29，95%置信区间为1.04，1.63，p = 0.02），但在考虑治疗因素后并不显著。女性接受溶栓治疗的可能性较小（37%对46%，p < 0.01）和阿司匹林治疗的可能性较小（83%对90%，p < 0.01），出院时使用β受体阻滞剂（33%对47%，p < 0.01）和阿司匹林（82%对88%，p < 0.01）的可能性较小，或安排进行血管造影、运动试验或血运重建的可能性较小。年龄调整消除了治疗方面的大部分差异。两年时的粗死亡率女性较高（比值比为1.81，95%置信区间为1.41，2.31，p = 0.00）。年龄、现有危险因素和急性治疗占了这种差异的大部分，出院时的治疗影响不大。
因AMI入院的患者，无论年龄或性别，都应接受最佳治疗。AMI后女性的预后较差，老年人阿司匹林和溶栓治疗不足可能是导致这种情况的原因。
