El-Menyar Ayman, Zubaid Mohammad, Rashed Wafa, Almahmeed Wael, Al-Lawati Jawad, Sulaiman Kadhim, Al-Motarreb Ahmed, Amin Haitham, R Singh, Al Suwaidi Jassim
Department of Cardiology, Hamad Medical Corporation Hospital, Doha, Qatar.
Am J Cardiol. 2009 Oct 15;104(8):1018-22. doi: 10.1016/j.amjcard.2009.06.003.
The aim of this study was to evaluate the gender differences in baseline characteristics, therapy, and outcomes in patients with acute coronary syndromes in 6 Middle Eastern countries. Over a 6-month period in 2007, 8,169 consecutive patients (74% men, 24% women) presenting with acute coronary syndromes were enrolled in a prospective, multicenter study from 6 adjacent Middle Eastern countries. Women were 9 years older than men and more likely to have diabetes, hypertension, and dyslipidemia. Women were more likely to present with unstable angina and more often had atypical presentations of ST elevation myocardial infarction. Compared to men, women were significantly less treated with beta blockers and antiplatelet therapy, whereas reperfusion therapy was nonsignificantly less used in women. In all patients with acute coronary syndromes, women not only ranked higher on Global Registry of Acute Coronary Events risk score but also had increased in-hospital mortality, 1.75 times that of men. This mortality difference persisted after adjusting for all confounders (odds ratios 1.76, 95% confidence interval 1.1 to 2.8, p <0.01). In conclusion, in addition to presentation with higher risk factors, female gender also independently predicted poorer outcomes in patients with ST elevation myocardial infarction.
本研究旨在评估中东6个国家急性冠脉综合征患者在基线特征、治疗及预后方面的性别差异。在2007年的6个月期间，来自中东6个相邻国家的8169例连续的急性冠脉综合征患者（74%为男性，24%为女性）被纳入一项前瞻性多中心研究。女性比男性年长9岁，且更易患糖尿病、高血压和血脂异常。女性更易表现为不稳定型心绞痛，且更常出现ST段抬高型心肌梗死的非典型表现。与男性相比，女性接受β受体阻滞剂和抗血小板治疗的比例显著更低，而女性接受再灌注治疗的比例略低但无显著差异。在所有急性冠脉综合征患者中，女性不仅在急性冠脉事件全球注册风险评分中更高，且住院死亡率增加，是男性的1.75倍。在对所有混杂因素进行校正后，这种死亡率差异仍然存在（比值比1.76，95%置信区间1.1至2.8，p<0.01）。总之，除了具有更高的危险因素外，女性性别也独立预测ST段抬高型心肌梗死患者的预后更差。
