Bosch Xavier, Casanovas Nuria, Miranda-Guardiola Faustino, Díez-Aja Salvador, Sitges Marta, Anguera Ignaci, Sanz Ginés, Betriu Amadeo
Institut de Malalties Cardiovasculars. Hospital Clínic. Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS). Departament de Medicina. Universitat de Barcelona. España.
Rev Esp Cardiol. 2002 Dec;55(12):1235-42. doi: 10.1016/s0300-8932(02)76795-x.
Women with ST-segment-elevation myocardial infarction have a worse prognosis than men. However, information about the prognosis of women with non-ST-segment-elevation acute coronary syndromes (NSTEACS) is scarce. The aim of this study was to determine if the long-term prognosis of men and women with NSTEACS differs.
Case-control study. In a consecutive series of 300 patients admitted for a NSTEACS and ischemic ECG changes, we compared the clinical characteristics, in-hospital and long-term follow-up of 95 women and 95 men matched for age, presence of diabetes, and past history of hypertension.
The median age of patients was 69 years, 36% had diabetes, and 65% had a history of hypertension. There were no gender differences in the history of angina or hypercholesterolemia, clinical presentation, number of patients with ST-segment depression, and CK-MB elevation. However, smoking, coronary artery disease, and peripheral vascular disease were less frequent in women. Treatment at admission and at discharge was similar in men and women, as was the use of in-hospital diagnostic and therapeutic procedures (echocardiography: 80 vs 88%; coronary angiography: 57 vs 59%; percutaneous coronary intervention: 17 vs 14%; coronary surgery 13 vs. 11%). Women had a better mean ejection fraction (55 13 vs 49 14%; p < 0.01) and fewer stenosed coronary vessels (1.4 1.1 vs 2.2 0.9; p < 0.01). There were no differences in the frequency of recurrent angina (28 vs 25%), death, or infarction (both 3.2%) during hospitalization. However, during a 30-month follow-up the incidence of death, myocardial infarction, or a new episode of NSTEACS was significantly lower in women with a relative risk (RR) of 0.53 (95% CI: 0.33-0.86; p < 0.01). This apparently better prognosis persisted after adjusting for clinical data and ejection fraction (RR: 0.57 (0.33-0.98); p < 0.05), but disappeared after adjusting for the number of diseased coronary vessels (RR: 0.71 (0.35-1.47); p = 0.36).
Women with NSTEACS had a better long-term prognosis than men. This better prognosis was independent of the patients' clinical characteristics and treatment, and could be explained by a less severe and less extensive coronary artery disease.
ST段抬高型心肌梗死女性患者的预后比男性差。然而，关于非ST段抬高型急性冠状动脉综合征（NSTEACS）女性患者预后的信息却很少。本研究的目的是确定NSTEACS男性和女性患者的长期预后是否存在差异。
病例对照研究。在连续收治的300例因NSTEACS和缺血性心电图改变入院的患者中，我们比较了95例年龄、糖尿病患病情况和高血压病史相匹配的女性患者与95例男性患者的临床特征、住院情况及长期随访情况。
患者的中位年龄为69岁，36%患有糖尿病，65%有高血压病史。在心绞痛病史或高胆固醇血症、临床表现、ST段压低患者数量以及肌酸激酶同工酶（CK-MB）升高方面，不存在性别差异。然而，女性吸烟、患冠状动脉疾病和外周血管疾病的情况较少见。男性和女性患者入院时及出院时的治疗情况相似，住院期间诊断和治疗程序的使用情况也相似（超声心动图检查：80%对88%；冠状动脉造影：57%对59%；经皮冠状动脉介入治疗：17%对14%；冠状动脉手术：13%对11%）。女性患者的平均射血分数较高（55±13对49±14；p<0.01），冠状动脉狭窄血管较少（1.4±1.1对2.2±0.9；p<0.01）。住院期间复发性心绞痛（28%对25%）、死亡或梗死（均为3.2%）的发生率没有差异。然而，在30个月的随访期间，女性患者死亡、心肌梗死或新的NSTEACS发作的发生率显著较低，相对风险（RR）为0.53（95%CI：0.33 - 0.86；p<0.01）。在对临床数据和射血分数进行调整后，这种明显较好的预后仍然存在（RR：0.57（0.33 - 0.98）；p<0.05），但在对病变冠状动脉血管数量进行调整后消失（RR：0.71（0.35 - 1.47）；p = 0.36）。
NSTEACS女性患者的长期预后比男性好。这种较好的预后独立于患者的临床特征和治疗情况，可能是由冠状动脉疾病不太严重和范围不太广泛所致。
