Hersi Ahmad, Al-Habib Khalid, Al-Faleh Husam, Al-Nemer Khalid, Alsaif Shukri, Taraben Amir, Kashour Tarek, Abuosa Ahmed Mohamed, Al-Murayeh Mushabab Ayedh
Dr. Ahmad Hersi, Colllege of Medicine,, King Saud University,, Cardaic Science,, King Khalid University Hospital,, Riyadh 11472, Saudi Arabia,
Ann Saudi Med. 2013 Jul-Aug;33(4):339-46. doi: 10.5144/0256-4947.2013.339.
Gender associations with acute coronary syndrome (ACS), remain inconsistent. Gender-specific data in the Saudi Project for Assessment of Coronary Events registry, launched in December 2005 and currently with 17 participating hospitals, were explored.
A prospective multicenter study of patient with ACS in secondary and tertiary care centers in Saudi Arabia were included in this analysis.
Patients enrolled from December 2005 until December 2007 included those presented to participating hospitals or transferred from non-registry hospitals. Summarized data were analyzed.
Of 5061 patients, 1142 (23%) were women. Women were more frequently diagnosed with non ST-segment elevation myocardial infarction (NSTEMI [43%]) than unstable angina (UA [29%]) or ST-segment elevation myocardial infarction (STEMI [29%]). More men had STEMI (42%) than NSTEMI (37%) or UA (22%). Men were younger than women (57 vs 63 years) who had more diabetes, hypertension, and hyperlipidemia. More men had a history of coronary artery disease. More women received angiotensin receptor blockers (ARB) and fewer had percutaneous coronary intervention (PCI). Gender differences in the subset of STEMI patients were similar to those in the entire cohort. However, gender differences in the subset of STEMI showed fewer women given b-blockers, and an insignificant PCI difference between genders. Thrombolysis rates between genders were similar. Overall, in-hospital mortality was significantly worse for women and, by ACS type, was significantly greater in women for STEMI and NSTEMI. However, after age adjustment there was no difference in mortality between men and women in patients with NSTEMI. The multivariate-adjusted (age, risk factors, treatments, door-to-needle time) STEMI gender mortality difference was not significant (OR=2.0, CI: 0.7-5.5; P=.14).
These data are similar to other reported data. However, differences exist, and their explanation should be pursued to provide a valuable insight into understanding ACS and improving its management.
急性冠状动脉综合征（ACS）与性别的关系仍不一致。本研究对沙特冠状动脉事件评估项目登记处的性别特异性数据进行了探究，该项目于2005年12月启动，目前有17家参与医院。
本分析纳入了沙特阿拉伯二级和三级护理中心对ACS患者进行的一项前瞻性多中心研究。
2005年12月至2007年12月纳入的患者包括那些到参与医院就诊或从非登记医院转诊的患者。对汇总数据进行了分析。
在5061例患者中，1142例（23%）为女性。女性被诊断为非ST段抬高型心肌梗死（NSTEMI[43%]）的频率高于不稳定型心绞痛（UA[29%]）或ST段抬高型心肌梗死（STEMI[29%]）。男性患STEMI（42%）的比例高于NSTEMI（37%）或UA（22%）。男性比女性年轻（57岁对63岁），女性患糖尿病、高血压和高脂血症的更多。更多男性有冠状动脉疾病史。更多女性接受血管紧张素受体阻滞剂（ARB）治疗，接受经皮冠状动脉介入治疗（PCI）的较少。STEMI患者亚组中的性别差异与整个队列中的相似。然而，STEMI亚组中的性别差异显示接受β受体阻滞剂治疗的女性较少，且性别之间的PCI差异不显著。两性之间的溶栓率相似。总体而言，女性的院内死亡率显著更高，按ACS类型划分，STEMI和NSTEMI女性的死亡率显著更高。然而，年龄调整后，NSTEMI患者中男性和女性的死亡率没有差异。多变量调整（年龄、危险因素、治疗、门到针时间）后的STEMI性别死亡率差异不显著（OR=2.0，CI：0.7 - 5.5；P = 0.14）。
这些数据与其他报告的数据相似。然而，差异仍然存在，应对其进行解释，以便为理解ACS和改善其管理提供有价值的见解。
