Hvelplund Anders, Galatius Søren, Madsen Mette, Sørensen Rikke, Madsen Jan Kyst, Iversen Allan Zeeberg, Tilsted Hans-Henrik, Helqvist Steffen, Mortensen Poul Erik, Nielsen Per Hostrup, Prescott Eva, Abildstrøm Steen Zabell
National Institute of Public Health, University of Southern Denmark, Øster Farimagsgade 5A, DK1399, Copenhagen K, Denmark.
J Invasive Cardiol. 2012 Jan;24(1):19-24.
To describe gender-specific long-term outcome and initiation of secondary preventive medication among patients with acute myocardial infarction (AMI).
Observational cohort study.
Nationwide registries.
We included 18,279 patients: 6364 women (35%) and 11,915 men (65%), admitted with AMI (median age, 67 years; range, 30-90 years) surviving for at least 2 months.
According to sex, patients were stratified by invasive treatment strategy: (1) revascularized; (2) examined with coronary angiography (CAG) but not revascularized; and (3) not examined with CAG.
All-cause mortality and readmission with AMI. Initiation of secondary preventive medication.
Of 18,279 patients with a first AMI who survived 2 months, 1857 women (29%) and 1756 men (15%) were not examined with CAG (P<.001), 1295 women (20%) and 1563 men (13%) were examined but not revascularized (P<.001), and 3212 women (51%) and 8596 men (72%) were revascularized (P<.001). Not being examined with CAG after AMI was associated with a three-fold increase in risk of death and, importantly, a 50% increase in the risk of a recurrent AMI compared with patients who were revascularized. Among patients who were revascularized, 85-92% initiated recommended secondary preventive medication compared to 46-71% in patients not examined with CAG (P<.001). Initiation of secondary preventive medication was higher in men (81-84%) than in women (73-79%; P<.001), which could be ascribed to the differences in invasive strategy.
In both sexes, those who were not examined had a highly increased risk of both recurrent AMI and death. Moreover, initiation of secondary preventive medication was closely related to the choice of invasive strategy disfavoring the women.
描述急性心肌梗死（AMI）患者的性别特异性长期预后及二级预防药物的使用情况。
观察性队列研究。
全国性登记处。
我们纳入了18279例患者，其中6364例女性（35%）和11915例男性（65%），因AMI入院（中位年龄67岁；范围30 - 90岁），存活至少2个月。
根据性别，患者按侵入性治疗策略分层：（1）接受血运重建；（2）接受冠状动脉造影（CAG）检查但未接受血运重建；（3）未接受CAG检查。
全因死亡率和AMI再入院情况。二级预防药物的使用情况。
在18279例首次发生AMI且存活2个月的患者中，1857例女性（29%）和1756例男性（15%）未接受CAG检查（P <.001），1295例女性（20%）和1563例男性（13%）接受了检查但未接受血运重建（P <.001），3212例女性（51%）和8596例男性（72%）接受了血运重建（P <.001）。与接受血运重建的患者相比，AMI后未接受CAG检查与死亡风险增加三倍相关，重要的是，复发性AMI风险增加50%。在接受血运重建的患者中，85 - 92%开始使用推荐的二级预防药物，而未接受CAG检查的患者中这一比例为46 - 71%（P <.001）。男性开始使用二级预防药物的比例（81 - 84%）高于女性（73 - 79%；P <.001），这可能归因于侵入性策略的差异。
在两性中，未接受检查的患者复发性AMI和死亡风险均显著增加。此外，二级预防药物的使用与侵入性策略的选择密切相关，女性处于不利地位。
