Rosengren Annika, Wallentin Lars, K Gitt Anselm, Behar Solomon, Battler Alexander, Hasdai David
Department of Medicine, Goteborg University, Sahlgrenska University Hospital, Ostra, SE-416 85 Goteborg, Sweden.
Eur Heart J. 2004 Apr;25(8):663-70. doi: 10.1016/j.ehj.2004.02.023.
To investigate sex differences in clinical presentation in younger and older patients hospitalised with a wide spectrum of acute coronary syndromes (ACS).
We analysed 10253 patients with a discharge diagnosis of ACS in the Euro Heart Survey of patients with Acute Coronary Syndromes. There were 1010 women and 3709 men < 65 years. Among patients <65 years, fewer women than men presented with ST elevation, (OR [odds ratio]: 0.62 [0.53-0.71]) and developed Q-wave myocardial infarction (OR 0.58 [0.50-0.67]), whereas in patients > or =65 years there was no significant sex difference. Women <65 years were more likely than men of the same age to be discharged with a diagnosis of unstable angina (OR 1.56 [1.35-1.79]), but there was no sex difference in older patients; the p for interaction between sex and age for both was <0.0001. Among patients who underwent coronary angiography, both younger and older women were less likely than men to have 3-vessel or main stem disease. In a logistic regression analysis stratified for age, female sex was a significant negative determinant of presenting with ST elevation in patients <65 years (OR 0.68 [0.58-0.79]), whereas there was no effect of sex in patients > or =65 years.
In younger patients with ACS, women were less likely than men to present with ST elevation and more likely to be discharged with a diagnosis of unstable angina. In older patients there were no differences in clinical presentation. Both older and younger women had less extensive atherosclerosis. The findings suggest a different pathophysiology of ACS in younger, but not older, women.
研究因广泛急性冠状动脉综合征（ACS）住院的年轻和老年患者临床表现中的性别差异。
我们在急性冠状动脉综合征患者的欧洲心脏调查中分析了10253例出院诊断为ACS的患者。年龄＜65岁的患者中有1010名女性和3709名男性。在年龄＜65岁的患者中，出现ST段抬高的女性比男性少（比值比[OR]：0.62[0.53 - 0.71]），发生Q波心肌梗死的女性也比男性少（OR 0.58[0.50 - 0.67]），而在年龄≥65岁的患者中，性别差异不显著。年龄＜65岁的女性比同年龄男性更有可能出院诊断为不稳定型心绞痛（OR 1.56[1.35 - 1.79]），但老年患者中无性别差异；两者性别与年龄之间的交互作用p均＜0.0001。在接受冠状动脉造影的患者中，年轻和老年女性患三支血管或主干病变的可能性均低于男性。在按年龄分层的逻辑回归分析中，女性性别是年龄＜65岁患者出现ST段抬高的显著负性决定因素（OR 0.68[0.58 - 0.79]），而在年龄≥65岁的患者中性别无影响。
在年轻的ACS患者中，女性出现ST段抬高的可能性低于男性，而出院诊断为不稳定型心绞痛的可能性高于男性。老年患者的临床表现无差异。老年和年轻女性的动脉粥样硬化程度均较轻。这些发现提示年轻女性而非老年女性的ACS病理生理机制不同。
