Chang Wei-Ching, Kaul Padma, Westerhout Cynthia M, Graham Michelle M, Fu Yuling, Chowdhury Tapan, Armstrong Paul W
Department of Medicine, University of Alberta, Edmonton, Canada.
Arch Intern Med. 2003 Nov 10;163(20):2476-84. doi: 10.1001/archinte.163.20.2476.
Patient sex has been shown to differentially affect mortality from unstable angina (UA) and acute myocardial infarction (AMI). However, to our knowledge, no prior population-based studies have examined both cohorts simultaneously to explain this intriguing variation. Hence, we undertook to explore and explain sex differences in 5-year mortality after UA and AMI.
We used an administrative database of 22 967 patients with AMI and 8441 patients with UA discharged from acute care hospitals in Alberta between April 1, 1993, and March 31, 2000.
Women were older with more baseline comorbidities, more frequently had a diagnosis of UA, and had 30% lower relative odds of undergoing revascularization than men. Kaplan-Meier estimates of 5-year mortality were similar between sexes after UA (women vs men, 21.6% vs 19.5%; P =.09) but markedly higher for women after AMI (38.5% vs 26.6%, P<.001). After adjustment for baseline characteristics and revascularization, the hazard ratios (95% confidence intervals) for women vs men were 0.81 (0.72-0.92) after UA and 0.99 (0.93-1.05) after AMI. Only women younger than 65 years were at a significantly higher risk after AMI. The reasons for this difference in sex-related outcomes between UA and AMI may relate to greater disparities in the AMI cohort with respect to age, comorbidities, neighborhood incomes, and referrals to cardiovascular specialists.
Relative to UA, AMI has a more serious impact on women than men, such that women have a survival advantage when afflicted with UA but lose that advantage with AMI. Additional investigation into the causes, treatment, and policy implications of the age-sex interaction is warranted.
患者性别已被证明对不稳定型心绞痛（UA）和急性心肌梗死（AMI）的死亡率有不同影响。然而，据我们所知，此前尚无基于人群的研究同时对这两个队列进行考察以解释这种有趣的差异。因此，我们着手探究并解释UA和AMI后5年死亡率的性别差异。
我们使用了1993年4月1日至2000年3月31日期间艾伯塔省急性护理医院出院的22967例AMI患者和8441例UA患者的管理数据库。
女性年龄更大，基线合并症更多，UA诊断更为常见，且血管重建的相对几率比男性低30%。UA后两性的5年死亡率的Kaplan-Meier估计值相似（女性对男性，21.6%对19.5%；P = 0.09），但AMI后女性的死亡率明显更高（38.5%对26.6%，P<0.001）。在对基线特征和血管重建进行调整后，女性对男性的风险比（95%置信区间）在UA后为0.81（0.72 - 0.92），在AMI后为0.99（0.93 - 1.05）。只有65岁以下的女性在AMI后风险显著更高。UA和AMI之间这种性别相关结局差异的原因可能与AMI队列在年龄、合并症、社区收入以及心血管专科转诊方面的更大差异有关。
相对于UA，AMI对女性的影响比对男性更严重，以至于女性患UA时具有生存优势，但患AMI时则失去该优势。有必要对年龄 - 性别相互作用的原因、治疗及政策影响进行进一步研究。
