Department of Cardiology, University Hospital Jean-Minjoz, Besançon, France.
Am J Cardiol. 2011 Sep 15;108(6):789-98. doi: 10.1016/j.amjcard.2011.04.031. Epub 2011 Jul 7.
The greater mortality observed in women compared to men after acute myocardial infarction remains unexplained. Using an analysis of pairs, matched on a conditional probability of being male (propensity score), we assessed the effect of the baseline characteristics and management on 30-day mortality. Consecutive patients were included from January 2006 to December 2007. Two propensity scores (for being male) were calculated, 1 from the baseline characteristics and 1 from both the baseline characteristics and treatment. Two matched cohorts were composed using 1:1 matching and computed using the best 8 digits of the propensity score. Paired analyses were performed using conditional regression analysis. During the study period, 3,510 patients were included in the registry; 1,119 (32%) were women. Compared to the men, the women were 10 years older, had more co-morbidities, less often underwent angiography and reperfusion, and received less medical treatment. The 30-day mortality rate was 12.3% (130 of 1,060) for the women and 7.2% (167 of 2,324) for the men (p <0.001). The 2 matched populations represented 1,298 and 1,168 patients. After matching using the baseline characteristics, the only difference in treatment was a lower rate of angiography and reperfusion, with a trend toward greater 30-day mortality in women. After matching using both baseline characteristics and treatment, the 30-day mortality was similar for the men and women, suggesting that the increased use of invasive procedures in women could potentially be beneficial. In conclusion, compared to men, the 30-day mortality is greater in women and explained primarily by differences in baseline characteristics and to a lesser degree by differences in management. The difference in the use of invasive procedures persisted after matching by characteristics. In contrast, after matching using the baseline characteristics and treatment, the 30-day mortality was comparable across the genders.
与男性相比，急性心肌梗死后女性的死亡率更高，但原因仍不清楚。本研究采用配对分析，根据男性的条件概率（倾向评分）进行匹配，评估了基线特征和治疗对 30 天死亡率的影响。连续患者纳入标准为 2006 年 1 月至 2007 年 12 月。通过基线特征和基线特征与治疗，分别计算了两个倾向评分（性别为男性）。使用 1:1 匹配并计算最佳 8 位数字的倾向评分，组成了两个匹配队列。使用条件回归分析进行配对分析。在研究期间，共有 3510 例患者纳入该登记研究，其中 1119 例（32%）为女性。与男性相比，女性年龄大 10 岁，合并症更多，接受血管造影和再灌注治疗的比例较低，接受的药物治疗也较少。女性 30 天死亡率为 12.3%（130/1060），男性为 7.2%（167/2324）（p<0.001）。匹配后的两个人群分别代表 1298 例和 1168 例患者。使用基线特征匹配后，治疗上唯一的差异是血管造影和再灌注治疗的比例较低，女性的 30 天死亡率有升高趋势。使用基线特征和治疗进行双重匹配后，男性和女性的 30 天死亡率相似，表明女性更倾向于使用侵入性操作，这可能是有益的。总之，与男性相比，女性的 30 天死亡率更高，主要与基线特征的差异有关，而与治疗的差异关系较小。在特征匹配后，侵入性操作的使用差异仍然存在。相反，在使用基线特征和治疗进行匹配后，两性的 30 天死亡率相当。
