Food and Drug Administration, Center for Devices and Radiological Health, Division of Epidemiology, USA.
Clin Cardiol. 2010 Feb;33(2):99-103. doi: 10.1002/clc.20691.
Women are at greater risk for worse outcomes associated with acute coronary syndrome (ACS) than are men. One explanation may be that they tend to be treated less aggressively than men even when more aggressive treatment is warranted. The purpose of this analysis was to assess this issue.
We used the Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation (CRUSADE) Quality Improvement Initiative registry, an observational data collection that began in November 2001, with retrospective data collection from January 2001 to December 2006. A total of 32,888 subjects met the inclusion/exclusion criteria for our study, based on strong biochemical evidence of myocardial infarction and acute onset of typical cardiac chest pain. We stratified subjects into 16 cells for coronary intervention, based on 4 age groups and 4 cardiac catheterization findings (insignificant, 1-vessel disease, 2-vessel disease, 3-vessel disease). We also stratified subjects into 20 cells for medical treatment, based on 4 age groups and 5 medical treatments. In each cell we compared the rate of coronary intervention (coronary artery bypass grafting or percutaneous coronary intervention) or medical treatment (glycoprotein IIb/IIIa inhibitors, aspirin, clopidogrel, beta-blocker, and statins) for men vs women.
Men demonstrated significantly higher rates (P < 0.05) of coronary intervention in 7 of the 16 cells and 9 of the 20 medical treatment cells, compared to no cells in which women had statistically higher rates than men.
These findings suggest that men are more likely than women to receive coronary intervention and to be medically treated when presenting with evidence of non-ST-segment myocardial infarction, controlled for age, cardiac catheterization findings, and biochemical evidence of myocardial infarction.
与男性相比，女性发生急性冠状动脉综合征（ACS）相关不良结局的风险更高。一种解释可能是，即使更积极的治疗是必要的，她们的治疗也往往不如男性积极。本分析的目的是评估这一问题。
我们使用了 Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes with Early Implementation（CRUSADE）质量改进倡议登记处，这是一项观察性数据收集，始于 2001 年 11 月，回顾性数据收集从 2001 年 1 月至 2006 年 12 月。共有 32888 名患者符合我们研究的纳入/排除标准，这些患者的心肌梗死和典型胸痛急性发作有强烈的生化证据。我们根据 4 个年龄组和 4 个心脏导管检查结果（无明显病变、单支血管病变、双支血管病变、三支血管病变）将患者分为 16 个细胞进行冠状动脉介入治疗。我们还根据 4 个年龄组和 5 种药物治疗将患者分为 20 个细胞进行药物治疗。在每个细胞中，我们比较了男性和女性接受冠状动脉介入治疗（冠状动脉旁路移植术或经皮冠状动脉介入治疗）或药物治疗（糖蛋白 IIb/IIIa 抑制剂、阿司匹林、氯吡格雷、β受体阻滞剂和他汀类药物）的比例。
与女性的比例相比，男性在 16 个细胞中的 7 个和 20 个药物治疗细胞中的 9 个细胞中，接受冠状动脉介入治疗的比例显著更高（P < 0.05）。
这些发现表明，在非 ST 段抬高型心肌梗死患者中，无论年龄、心脏导管检查结果和心肌梗死的生化证据如何，男性比女性更有可能接受冠状动脉介入治疗和药物治疗。
