Raine R A, Black N A, Bowker T J, Wood D A
Department of Public Health and Policy, London School of Hygiene and Tropical Medicine, London, UK.
J Epidemiol Community Health. 2002 Oct;56(10):791-7. doi: 10.1136/jech.56.10.791.
s: To compare the clinical management and health outcomes of men and women after admission with acute coronary syndromes, after adjusting for disease severity, sociodemographic, and cardiac risk factors.
Prospective national survey of acute cardiac admissions followed up by mailed patient questionnaire two to three years after initial admission.
Random sample of 94 district general hospitals in the UK.
1064 patients under 70 years old recruited between April 1995 and November 1996.
Of the 1064 patients recruited, 126 (11.8%) died before follow up. Of the 938 survivors, 719 (76.7%) completed a follow up questionnaire. There were no gender differences in the use of cardiac investigations during the index admission or follow up period. However, male patients with hypertension were more likely to undergo rehabilitation compared with female hypertensive patients (OR 2.01, 95% CI 0.85 to 4.72). Men were also more likely to undergo coronary artery bypass grafting (CABG) than women (OR 1.90, 95%CI 1.21 to 3.00), but there was no gender difference in the use of revascularisation overall (p=0.14). An indirect indication that the gender differences in CABG were not attributable to bias was provided by the lack of gender differences in health outcomes, which implies that patients received the care they needed.
Despite the extensive international literature referring to a gender bias in favour of men with coronary heart disease, this national survey found no gender differences in the use of investigations or in revascularisation overall. However, the criteria used for selecting percutaneous transluminal coronary angioplasty compared with CABG requires further investigation as does the use of rehabilitation. It is unclear whether the clinical decisions to provide these procedures are made solely on the basis of clinical need.
比较急性冠状动脉综合征入院后经疾病严重程度、社会人口统计学和心脏危险因素校正的男性和女性的临床管理及健康结局。
对急性心脏入院患者进行前瞻性全国性调查，并在首次入院后两到三年通过邮寄患者问卷进行随访。
英国94家地区综合医院的随机样本。
1995年4月至1996年11月招募的1064名70岁以下患者。
在招募的1064名患者中，126名（11.8%）在随访前死亡。在938名幸存者中，719名（76.7%）完成了随访问卷。在首次入院期间或随访期间，心脏检查的使用方面没有性别差异。然而，与女性高血压患者相比，男性高血压患者更有可能接受康复治疗（比值比2.01，95%置信区间0.85至4.72）。男性接受冠状动脉旁路移植术（CABG）的可能性也高于女性（比值比1.90，95%置信区间1.21至3.00），但总体血管重建的使用方面没有性别差异（p=0.14）。健康结局方面缺乏性别差异间接表明CABG中的性别差异并非由偏倚所致，这意味着患者得到了他们所需的治疗。
尽管有大量国际文献提及冠心病男性存在性别偏倚，但这项全国性调查发现，在检查的使用或总体血管重建方面没有性别差异。然而，与CABG相比，经皮腔内冠状动脉成形术的选择标准以及康复治疗的使用都需要进一步研究。尚不清楚提供这些治疗措施的临床决策是否仅基于临床需求做出。
