不稳定型心绞痛的临床管理及预后不存在性别差异。

No gender difference in the clinical management and outcome of unstable angina.

作者信息

Ben-Ami Tal, Gilutz Harel, Porath Avi, Sosna Gilat, Liel-Cohen Noah

机构信息

Cardiology Division, Soroka University Medical Center, Beer Sheva, Israel.

出版信息

Isr Med Assoc J. 2005 Apr;7(4):228-32.

PMID:15847201

Abstract

BACKGROUND

Women with myocardial infarction have a less favorable prognosis than men. Many studies have indicated gender bias in the evaluation and treatment of myocardial infarction, but few data exist concerning these aspects in the management of unstable angina.

OBJECTIVE

To investigate gender differences in the baseline characteristics, clinical presentation, treatment and prognosis of women with unstable angina.

METHOD

Data were collected prospectively as part of the Acute Coronary Syndromes Israeli Survey in 2000 at Soroka University Medical Center. In-hospital management and 2 year follow-up were monitored for 226 consecutive patients with unstable angina admitted to our medical center during February and March 2000.

RESULTS

Women were older (71 +/- 12 vs. 66 +/- 12, P = 0.006), more diabetic (41.3% vs. 34.5%, not significant) and hypertensive (76.3% vs. 64.6%, P = 0.07). Women presented more often with atypical chest pain (18.8% vs. 7.5%, P = 0.038). Heparin, aspirin and angiotensin-converting enzyme inhibitor were delivered equally, but more beta-blockers were administered to women (88.5% vs. 75.7%, P = 0.02) and more statins to men (48.1% vs. 35.4%, P = 0.07). Angiography rates were similar (17.7% vs. 19.6%). Similar management was documented during the 2 year follow-up. Re-hospitalization rates were similar (53.3% of women and 63.7% of men, NS). Men had a tendency to develop acute myocardial infarction more often (9.6% vs. 2.7%, P = 0.06) and to develop peripheral vascular disease (3.7% vs. 0%, P = 0.09), and they had a non-significant higher rate of coronary artery bypass graft (6.7% vs. 1.3%, P = 0.08). No gender difference was found in angiography (14.7% of women vs. 16.3% of men) or percutaneous intervention (13% vs. 16.7%). At 2 years there was no gender-related difference in mortality (13.3% of women vs. 16.3% of , NS). Kaplan-Meier analysis for event-free survival after 2 years showed no gender difference in survival. Multi-regression analysis showed that gender was not a prognostic factor for survival.

CONCLUSIONS

We found no major difference in the management of men and women with unstable angina. Although men showed a tendency to suffer more major cardiac events, their 2 year prognosis was the same as for women.

摘要

背景

心肌梗死女性患者的预后比男性差。许多研究表明，在心肌梗死的评估和治疗中存在性别偏见，但关于不稳定型心绞痛管理方面的此类数据较少。

目的

探讨不稳定型心绞痛女性患者在基线特征、临床表现、治疗及预后方面的性别差异。

方法

作为2000年以色列急性冠状动脉综合征调查的一部分，前瞻性收集索罗卡大学医学中心的数据。对2000年2月和3月连续入住我们医学中心的226例不稳定型心绞痛患者进行住院管理及2年随访监测。

结果

女性年龄更大（71±12岁对66±12岁，P = 0.006），糖尿病患者更多（41.3%对34.5%，无统计学意义），高血压患者更多（76.3%对64.6%，P = 0.07）。女性更常表现为非典型胸痛（18.8%对7.5%，P = 0.038）。肝素、阿司匹林和血管紧张素转换酶抑制剂的使用相当，但女性使用β受体阻滞剂更多（88.5%对75.7%，P = 0.02），男性使用他汀类药物更多（48.1%对35.4%，P = 0.07）。血管造影率相似（17.7%对19.6%）。在2年随访期间记录到相似的管理情况。再住院率相似（女性为53.3%，男性为63.7%，无统计学差异）。男性发生急性心肌梗死的倾向更高（9.6%对2.7%，P = 0.06），发生外周血管疾病的倾向更高（3.7%对0%，P = 0.09），冠状动脉旁路移植术的发生率略高但无统计学意义（6.7%对1.3%，P = 0.08）。血管造影（女性为14.7%，男性为16.3%）或经皮介入治疗（13%对16.7%）方面未发现性别差异。2年时死亡率无性别相关差异（女性为13.3%，男性为16.3%，无统计学意义）。2年后无事件生存的Kaplan-Meier分析显示生存无性别差异。多元回归分析表明性别不是生存的预后因素。