Greenland P, Reicher-Reiss H, Goldbourt U, Behar S
Neufeld Cardiac Research Institute, Chaim Sheba Medical Center, Tel Hashomer, Israel.
Circulation. 1991 Feb;83(2):484-91. doi: 10.1161/01.cir.83.2.484.
We determined in-hospital and 1-year prognoses after acute myocardial infarction (MI) in 5,839 consecutive patients derived from 14 of 21 coronary care units in Israel during 1981-1983. Age-adjusted in-hospital mortality was 23.1% in 1,524 women and 15.7% in 4,315 men (p less than 0.0005). One-year age-adjusted mortality rates in patients surviving hospitalization were 11.8% in women and 9.3% in men (p = 0.03). Cumulative age-adjusted 1-year mortality rates were 31.8% in women and 23.1% in men (p less than 0.0005). Relative odds of mortality, covariate-adjusted for major prognostic factors that included age, prior MI, congestive heart failure, and infarct location by electrocardiogram, indicated that female gender was independently and significantly associated with increased mortality both during hospitalization (relative odds, 1.72; 95% confidence interval, 1.45-2.04) and at 1 year after discharge (relative odds, 1.32; 95% confidence interval, 1.05-1.66). In separate multivariate analyses for each gender, a major factor that emerged as a predictor of outcome in women, but not in men, was a reported history of diabetes mellitus, both for in-hospital mortality and for 1-year mortality. However, even in the nondiabetics in this population, female gender was a significant, independent predictor of in-hospital mortality. The findings of the present study substantiate that women fare worse than men after suffering an acute MI, that increased age does not fully account for the increased mortality in women, and that diabetic women are at particularly high risk once MI has occurred.
我们对1981 - 1983年期间来自以色列21个冠心病监护病房中14个病房的5839例连续急性心肌梗死（MI）患者的院内及1年预后进行了研究。年龄调整后的院内死亡率在1524名女性中为23.1%，在4315名男性中为15.7%（p<0.0005）。住院存活患者的年龄调整后1年死亡率女性为11.8%，男性为9.3%（p = 0.03）。年龄调整后的累积1年死亡率女性为31.8%，男性为23.1%（p<0.0005）。对包括年龄、既往心肌梗死、充血性心力衰竭和心电图梗死部位等主要预后因素进行协变量调整后的死亡相对比值表明，女性性别在住院期间（相对比值，1.72；95%置信区间，1.45 - 2.04）和出院后1年（相对比值，1.32；95%置信区间，1.05 - 1.66）均与死亡率增加独立且显著相关。在针对每种性别的单独多变量分析中，一个在女性而非男性中成为结局预测因素的主要因素是糖尿病病史，无论是对于院内死亡率还是1年死亡率。然而，即使在该人群中的非糖尿病患者中，女性性别也是院内死亡率的一个显著、独立预测因素。本研究结果证实，急性心肌梗死后女性的预后比男性差，年龄增加并不能完全解释女性死亡率的增加，并且一旦发生心肌梗死，糖尿病女性的风险特别高。
