Vogel Birgit, Farhan Serdar, Hahne Sarah, Kozanli Ilyas, Kalla K, Freynhofer Matthias K, Jarai Rudolf, Kautzky-Willer Alexandra, Huber Kurt
3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria
3rd Medical Department with Cardiology, Wilhelminen Hospital, Vienna, Austria.
Eur Heart J Acute Cardiovasc Care. 2016 Aug;5(4):347-53. doi: 10.1177/2048872615585514. Epub 2015 May 7.
To detect sex-related differences in baseline characteristics, management and outcome in patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS).
Data from 812 consecutive patients admitted to our cardiology department for NSTE-ACS between 2001 and 2004 were obtained. Early invasive therapy was defined as revascularization during first hospital stay. A seven-year follow-up for the clinical endpoint of all-cause mortality could be obtained in 342 women and 440 men, respectively.
Compared with men, women were significantly older and more likely to suffer from renal insufficiency. The proportion treated with clopidogrel at admission was 43.6% for women and 52.7% for men, respectively (p=0.011). Significantly fewer women underwent an early invasive therapy compared with men (27.5% vs. 35.2%; p=0.021). Age and renal insufficiency were the strongest predictors for a conservative approach in both female and male patients. After adjustment for baseline characteristics there was no significant difference in treatment between women and men (odds ratio 0.89; 95% confidence interval 0.59-1.35; p=0.588). While in-hospital mortality was similar between the sexes, long-term mortality was significantly higher in women compared with men (8.2% vs. 7.0%; p=0.549 for in-hospital mortality and 54.8% vs. 39.3%; p<0.001 for seven-year mortality). However, after adjustment for baseline characteristics and treatment there was no significant difference in long-term mortality between women and men (hazard ratio 1.14; 95% confidence interval 0.89-1.47; p=0.307).
In these patients with NSTE-ACS women were less likely to undergo an early invasive therapy compared with men due to their higher age and the higher rate of renal insufficiency. After adjustment for age, comorbidities and treatment female sex was not associated with worse long-term outcome.
检测非ST段抬高型急性冠脉综合征（NSTE-ACS）患者在基线特征、治疗及预后方面的性别差异。
获取了2001年至2004年间因NSTE-ACS入住我院心内科的812例连续患者的数据。早期侵入性治疗定义为首次住院期间的血运重建。分别对342名女性和440名男性进行了为期七年的全因死亡率临床终点随访。
与男性相比，女性年龄显著更大，且更易患肾功能不全。入院时接受氯吡格雷治疗的比例女性为43.6%，男性为52.7%（p=0.011）。与男性相比，接受早期侵入性治疗的女性明显更少（27.5%对35.2%；p=0.021）。年龄和肾功能不全是女性和男性采取保守治疗方法的最强预测因素。在对基线特征进行调整后，女性和男性在治疗方面无显著差异（比值比0.89；95%置信区间0.59-1.35；p=0.588）。虽然两性住院死亡率相似，但女性长期死亡率显著高于男性（住院死亡率：8.2%对7.0%；p=0.549；七年死亡率：54.8%对39.3%；p<0.001）。然而，在对基线特征和治疗进行调整后，女性和男性的长期死亡率无显著差异（风险比1.14；95%置信区间0.89-1.47；p=0.307）。
在这些NSTE-ACS患者中，由于年龄较大和肾功能不全发生率较高，女性接受早期侵入性治疗的可能性低于男性。在对年龄、合并症和治疗进行调整后，女性性别与较差的长期预后无关。
