退伍女兵与急性心肌梗死后的预后

Women veterans and outcomes after acute myocardial infarction.

作者信息

Wheeler Stephanie, Bowen Jennie D, Maynard Charles, Lowy Elliot, Sun Haili, Sales Anne E, Smith Nicholas L, Fihn Stephan D

机构信息

VA Northwest Health Services Research and Development Center of Excellence, VA Puget Sound Health Care System, S-111-GIMC, 1660 South Columbian Way, Seattle, WA 98108, USA.

出版信息

J Womens Health (Larchmt). 2009 May;18(5):613-8. doi: 10.1089/jwh.2008.1073.

DOI:10.1089/jwh.2008.1073

PMID:19392640

Abstract

BACKGROUND

Previous studies have shown that women have decreased survival and receive fewer cardiac procedures after acute myocardial infarction (AMI) compared with men, raising concerns for sexual bias in provision of care. The objective of this study is to describe clinical characteristics, treatment, and survival in women veterans compared with men after admission to VA hospitals for AMI.

METHODS

This is a retrospective inception cohort study using data drawn from the VA Cardiac Care Follow-up Clinical Study, describing patients admitted for AMI to VA hospitals from October 1, 2003 to March 31, 2005. Subjects were followed for 1 year.

RESULTS

There were 236 women and 13,259 men admitted during the study period to VA hospitals with AMI. Women were less likely to have a history of heart failure compared with men (18.2% of women vs. 27.2% of men, p = 0.002) and previous coronary artery bypass grafting (CABG) (11.4% of women vs. 19.6% of men, p = 0.002). Diagnostic cardiac catheterization was similar in women and men (36.9% and 34.9%, p = 0.539). Crude in-hospital mortality was 4.2% for women and 7.6% for men (p = 0.051). After adjusting for comorbidities and treatment variables, in-hospital mortality was not significantly different for women compared with men (hazard ratio [HR] 0.82, 95% confidence interval [CI] 0.60-1.12).

CONCLUSIONS

Women veterans receive a level of care similar to men veterans for MI treated in VA hospitals. Differences in mortality between women and men were not significant and do not suggest that women fare worse.

摘要

背景

既往研究表明，与男性相比，女性急性心肌梗死（AMI）后生存率降低，接受的心脏手术较少，这引发了对医疗服务中性别偏见的担忧。本研究的目的是描述与男性相比，退伍军人女性患者因AMI入住退伍军人事务部（VA）医院后的临床特征、治疗情况和生存率。

方法

这是一项回顾性起始队列研究，使用从VA心脏护理随访临床研究中提取的数据，描述2003年10月1日至2005年3月31日期间因AMI入住VA医院的患者。对受试者进行了1年的随访。

结果

在研究期间，有236名女性和13259名男性因AMI入住VA医院。与男性相比，女性有心力衰竭病史的可能性较小（女性为18.2%，男性为27.2%，p = 0.002），既往有冠状动脉旁路移植术（CABG）的可能性也较小（女性为11.4%，男性为19.6%，p = 0.002）。女性和男性的诊断性心导管检查相似（分别为36.9%和34.9%，p = 0.539）。女性的院内粗死亡率为4.2%，男性为7.6%（p = 0.051）。在调整合并症和治疗变量后，女性与男性的院内死亡率无显著差异（风险比[HR]为0.82，95%置信区间[CI]为0.60 - 1.12）。