Kanamasa Ken, Ishikawa Kinji, Hayashi Takahiro, Hoshida Shiro, Yamada Yoshio, Kawarabayashi Takahiko, Naka Masashi, Yokoi Yoshiaki, Matsuda Mitsuo, Ogawa Iwao
Department of Vascular and Geriatric Medicine, Kinki University School of Medicine, 377-2 Ohno-Higashi, Osakasayama, Osaka 589-8511.
Intern Med. 2004 Oct;43(10):911-8. doi: 10.2169/internalmedicine.43.911.
It has been reported that women with acute myocardial infarction (AMI) have a higher short-term mortality rate than men, but the reason is not known. The profile in relation to age, gender and risk factors was evaluated to compare AMI and unstable angina pectoris (UAP).
Findings from 984 patients including 580 patients with AMI (129 women, 451 men) and 404 patients with UAP (131 women, 273 men) were analyzed by the South Osaka Acute Coronary Syndrome Study Group (SACS). The primary endpoint of the study was in-hospital death. The primary endpoints of interest (cardiac death) were fatal recurrent myocardial infarction, death from congestive heart failure, and sudden death.
Cardiac death during hospitalization within 30 days in AMI was higher in women than in men (12.4% vs 6.7%, p < 0.05). On the other hand, in UAP there was no significant difference between women and men (1.5% vs 0.7%, NS). The incidence of cardiac death in AMI was significantly higher for patients 75 years old and older (19.0%) than for patients less than 55 years old (4.2%), 55-64 years old (3.5%) and 65-74 years old (4.7%) (p < 0.001, respectively).
Cardiac death was higher for women compared with men in patients with AMI. The worse prognosis for the AMI women patients was likely to be derived from less performance of percutaneous coronary intervention, and a high incidence of severe myocardial infarction. Further research should be focused on the analysis of various clinical backgrounds.
据报道，急性心肌梗死（AMI）女性患者的短期死亡率高于男性，但其原因尚不清楚。本研究评估了与年龄、性别和危险因素相关的特征，以比较AMI和不稳定型心绞痛（UAP）。
日本大阪南部急性冠状动脉综合征研究组（SACS）分析了984例患者的研究结果，其中包括580例AMI患者（129例女性，451例男性）和404例UAP患者（131例女性，273例男性）。该研究的主要终点是住院死亡。主要关注的终点（心源性死亡）是致命性复发性心肌梗死、充血性心力衰竭死亡和猝死。
AMI患者中，女性住院30天内心源性死亡高于男性（12.4%对6.7%，p<0.05）。另一方面，在UAP患者中，女性和男性之间无显著差异（1.5%对0.7%，无统计学意义）。75岁及以上AMI患者的心源性死亡发生率（19.0%）显著高于55岁以下患者（4.2%）、55 - 64岁患者（3.5%）和65 - 74岁患者（4.7%）（p分别<0.001）。
AMI患者中，女性的心源性死亡高于男性。AMI女性患者预后较差可能是由于经皮冠状动脉介入治疗的实施较少以及严重心肌梗死的发生率较高。进一步的研究应集中在对各种临床背景的分析上。
