Steingart R M, Packer M, Hamm P, Coglianese M E, Gersh B, Geltman E M, Sollano J, Katz S, Moyé L, Basta L L
Winthrop-University Hospital, Mineola, NY 11501.
N Engl J Med. 1991 Jul 25;325(4):226-30. doi: 10.1056/NEJM199107253250402.
Despite the fact that coronary artery disease is the leading cause of death among women, previous studies have suggested that physicians are less likely to pursue an aggressive approach to coronary artery disease in women than in men. To define this issue further, we compared the care previously received by men and women who were enrolled in a large postinfarction intervention trial.
We assessed the nature and severity of anginal symptoms and the use of antianginal and antiischemic interventions before enrollment in the 1842 men and 389 women with left ventricular ejection fractions less than or equal to 40 percent after an acute myocardial infarction who were randomized in the Survival and Ventricular Enlargement trial.
Before their index infarction, women were as likely as men to have had angina and to have been treated with antianginal drugs. However, despite reports by women of symptoms consistent with greater functional disability from angina, fewer women had undergone cardiac catheterization (15.4 percent of women vs. 27.3 percent of men, P less than 0.001) or coronary bypass surgery (5.9 percent of women vs. 12.7 percent of men, P less than 0.001). When these differences were adjusted for important covariates, men were still twice as likely to undergo an invasive cardiac procedure as women, but bypass surgery was performed with equal frequency among the men and women who did undergo cardiac catheterization.
Physicians pursue a less aggressive management approach to coronary disease in women than in men, despite greater cardiac disability in women.
尽管冠状动脉疾病是女性死亡的主要原因，但先前的研究表明，与男性相比，医生对女性冠状动脉疾病采取积极治疗方法的可能性较小。为了进一步明确这一问题，我们比较了参与一项大型心肌梗死后干预试验的男性和女性之前接受的治疗情况。
我们评估了1842名男性和389名女性在急性心肌梗死后左心室射血分数小于或等于40%并被随机分配到“生存与心室扩大试验”中的心绞痛症状的性质和严重程度，以及抗心绞痛和抗缺血干预措施的使用情况。
在发生首次心肌梗死之前，女性患心绞痛和接受抗心绞痛药物治疗的可能性与男性相同。然而，尽管女性报告的症状表明心绞痛导致的功能残疾更严重，但接受心脏导管检查的女性较少（女性为15.4%，男性为27.3%，P<0.001），接受冠状动脉搭桥手术的女性也较少（女性为5.9%，男性为12.7%，P<0.001）。在对重要的协变量进行调整后，男性接受侵入性心脏手术的可能性仍是女性的两倍，但在接受心脏导管检查的男性和女性中，进行搭桥手术的频率相同。
尽管女性的心脏残疾更严重，但医生对女性冠状动脉疾病的治疗方法不如对男性积极。
