Milcent Carine, Dormont Brigitte, Durand-Zaleski Isabelle, Steg Philippe Gabriel
PSE Paris-Jourdan Sciences Economiques (L'Ecole des Hautes Etudes en Sciences Sociales, Centre National de la Recherche Scientifique), Paris, France.
Circulation. 2007 Feb 20;115(7):833-9. doi: 10.1161/CIRCULATIONAHA.106.664979.
Women with acute myocardial infarction have a higher hospital mortality rate than men. This difference has been ascribed to their older age, more frequent comorbidities, and less frequent use of revascularization. The aim of this study is to assess these factors in relation to excess mortality in women.
All hospital admissions in France with a discharge diagnosis of acute myocardial infarction were extracted from the national payment database. Logistic regression on mortality was performed for age, comorbidities, and coronary interventions. Nonparametric microsimulation models estimated the percutaneous coronary intervention and mortality rates that women would experience if they were "treated like men." Data were analyzed from 74,389 patients hospitalized with acute myocardial infarction, 30.0% of whom were women. Women were older (75 versus 63 years of age; P<0.001) and had a higher rate of hospital mortality (14.8% versus 6.1%; P<0.0001) than men. Percutaneous coronary interventions were more frequent in men (7.4% versus 4.8%; 24.4% versus 14.2% with stent; P<0.001). Mortality adjusted for age and comorbidities was higher in women (P<0.001), with an excess adjusted absolute mortality of 1.95%. Simulation models related 0.46% of this excess to reduced use of procedures. Survival benefit related to percutaneous coronary intervention was lower among women.
The difference in mortality rate between men and women with acute myocardial infarction is due largely to the different age structure of these populations. However, age-adjusted hospital mortality was higher for women and was associated with a lower rate of percutaneous coronary intervention. Simulations suggest that women would derive benefit from more frequent use of percutaneous coronary intervention, although these procedures appear less protective in women than in men.
急性心肌梗死女性患者的院内死亡率高于男性。这种差异归因于她们年龄较大、合并症更常见以及血运重建术的使用频率较低。本研究的目的是评估这些因素与女性额外死亡率的关系。
从国家支付数据库中提取法国所有出院诊断为急性心肌梗死的住院病例。对年龄、合并症和冠状动脉干预措施进行死亡率的逻辑回归分析。非参数微观模拟模型估计了女性若“像男性一样接受治疗”时将经历的经皮冠状动脉介入治疗和死亡率。对74389例急性心肌梗死住院患者的数据进行了分析，其中30.0%为女性。女性年龄更大（75岁对63岁；P<0.001），院内死亡率更高（14.8%对6.1%；P<0.0001）。男性经皮冠状动脉介入治疗更频繁（7.4%对4.8%；使用支架时为24.4%对14.2%；P<0.001）。调整年龄和合并症后的死亡率女性更高（P<0.001），调整后的绝对额外死亡率为1.95%。模拟模型将这一额外死亡率的0.46%归因于手术使用减少。女性经皮冠状动脉介入治疗的生存获益较低。
急性心肌梗死男性和女性患者死亡率的差异很大程度上归因于这些人群不同的年龄结构。然而，女性年龄调整后的院内死亡率更高，且与较低的经皮冠状动脉介入治疗率相关。模拟结果表明，女性更频繁地使用经皮冠状动脉介入治疗会有获益，尽管这些手术对女性的保护作用似乎不如对男性。
