Patel Amisha, Vishwanathan Sunitha, Nair Tiny, Bahuleyan C G, Jayaprakash V L, Baldridge Abigail, Huffman Mark D, Prabhakaran Dorairaj, Mohanan P P
Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA; Department of Medicine-Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Department of Cardiology, Government Tirumala Devaswom Medical College, Vandanam, Alappuzha, India.
Glob Heart. 2015 Dec;10(4):273-80. doi: 10.1016/j.gheart.2015.06.002. Epub 2015 Sep 26.
Previous literature from high-income countries has repeatedly shown sex differences in the presentation, diagnosis, and management of acute coronary syndromes (ACS), with women having atypical presentations and undergoing less aggressive diagnostic and therapeutic measures. However, much less data exist evaluating sex differences in ACS in India.
This study sought to evaluate sex differences in the diagnosis, management, and treatment of patients with ACS in Kerala, India.
The Kerala ACS Registry collected data from 25,748 consecutive ACS admissions (19,923 men and 5,825 women) from 125 hospitals in the Indian state of Kerala from 2007 to 2009. This study evaluated the association between sex differences in presentation, in-hospital management, and discharge care with in-hospital mortality and in-hospital major adverse cardiovascular events (defined as death, reinfarction, stroke, heart failure, or cardiogenic shock).
Women with ACS were older than men with ACS (64 vs. 59, p < 0.001) and were more likely to have a history of previous myocardial infarction (16% vs. 14%, p < 0.001). Inpatient diagnostics and management and discharge care were similar between sexes. No significant differences between men and women in the outcome of death (odds ratio [OR]: 1.05, 95% confidence interval [CI]: 0.80 to 1.38) or in the composite outcome of death, reinfarction, stroke, heart failure, or cardiogenic shock (OR: 0.99, 95% CI: 0.79 to 1.25) were seen after adjustment for possible confounding factors.
In Kerala, even though women with ACS were older and more likely to have previous myocardial infarction, there were no significant differences in in-hospital and discharge management, in-hospital mortality, or major adverse cardiovascular events between sexes. Whether these results apply to other parts of India or acute presentations of other chronic diseases in low- and middle-income countries warrants further study.
来自高收入国家的既往文献反复表明，急性冠状动脉综合征（ACS）在发病表现、诊断和治疗方面存在性别差异，女性表现不典型，接受的诊断和治疗措施也不够积极。然而，评估印度ACS性别差异的数据要少得多。
本研究旨在评估印度喀拉拉邦ACS患者在诊断、管理和治疗方面的性别差异。
喀拉拉邦ACS登记处收集了2007年至2009年印度喀拉拉邦125家医院连续25748例ACS住院患者的数据（男性19923例，女性5825例）。本研究评估了发病表现、住院管理和出院护理方面的性别差异与住院死亡率和住院期间主要不良心血管事件（定义为死亡、再梗死、中风、心力衰竭或心源性休克）之间的关联。
ACS女性患者比男性患者年龄更大（64岁对59岁，p<0.001），且更有可能有既往心肌梗死病史（16%对14%，p<0.001）。男女住院诊断、管理和出院护理情况相似。在对可能的混杂因素进行调整后，男性和女性在死亡结局（优势比[OR]：1.05，95%置信区间[CI]：0.80至1.38）或死亡、再梗死、中风、心力衰竭或心源性休克的综合结局（OR：0.99，95%CI：0.79至1.25）方面没有显著差异。
在喀拉拉邦，尽管ACS女性患者年龄更大且更有可能有既往心肌梗死病史，但男女在住院和出院管理、住院死亡率或主要不良心血管事件方面没有显著差异。这些结果是否适用于印度其他地区或低收入和中等收入国家其他慢性病的急性表现，值得进一步研究。
