Chen Yiping, Jiang Lixin, Smith Margaret, Pan Hongchao, Collins Rory, Peto Richard, Chen Zhengming
Clinical Trial Service Unit & Epidemiological Studies Unit (CTSU), Nuffield Department of Clinical Medicine, University of Oxford, Oxford, UK; China Oxford Centre for International Health Research, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, PR China.
China Oxford Centre for International Health Research, Fuwai Hospital, Chinese Academy of Medical Sciences, Beijing, PR China.
Heart Asia. 2011 Jan 1;3(1):104-10. doi: 10.1136/heartasia-2011-010003. eCollection 2011.
To assess the sex difference in hospital mortality following ST elevation myocardial infarction (STEMI) in China.
Observational study of patients enrolled into a large trial, adjusting for age, presenting characteristics and hospital treatments using logistic regression.
1250 hospitals in China during 1999-2005.
42 683 STEMI patients, including 31 309 men and 11 374 women.
In the original trial, all patients received 162 mg of aspirin plus 75 mg of clopidogrel daily or matching placebo and metoprolol (15 mg intravenous then 200 mg oral daily) or matching placebo. All other aspects of patients' treatments were at the discretion of responsible doctors.
Hospital mortality from any cause during the scheduled trial treatment period (ie, up to 4 weeks in hospital).
Overall, 8% of the patients died in hospital, with the crude hospital mortality being twice as high in women as in men (12.6% vs 6.3%). After adjusting for age, the sex difference in hospital mortality attenuated but remained highly significant (OR 1.54; 95% CI 1.43 to 1.66). Further adjustment for other baseline characteristics and for the treatments given in hospital had little effect on the sex difference in hospital mortality (OR 1.50, 95% CI 1.38 to 1.62). The difference in hospital mortality was greater at a younger age, with the adjusted ORs being 2.14, 1.70, 1.48 and 1.18, respectively, for ages <55, 55-64, 65-74 and ≥75 years (p=0.0001 for trend).
Compared with men of the same age, women had approximately a 50% higher mortality following hospital admission for STEMI, with a particularly higher excess risk at age <55 years.
评估中国ST段抬高型心肌梗死（STEMI）患者住院死亡率的性别差异。
对纳入一项大型试验的患者进行观察性研究，采用逻辑回归分析对年龄、临床表现特征及医院治疗情况进行校正。
1999年至2005年期间中国的1250家医院。
42683例STEMI患者，其中男性31309例，女性11374例。
在原试验中，所有患者每日服用162毫克阿司匹林加75毫克氯吡格雷或相应安慰剂，以及美托洛尔（静脉注射15毫克，然后每日口服200毫克）或相应安慰剂。患者治疗的所有其他方面由负责医生自行决定。
在预定的试验治疗期（即住院长达4周）内任何原因导致的住院死亡率。
总体而言，8%的患者在医院死亡，女性的粗住院死亡率是男性的两倍（12.6%对6.3%）。校正年龄后住院死亡率的性别差异有所减弱，但仍非常显著（比值比1.54；95%可信区间1.43至1.66）。进一步校正其他基线特征及住院期间给予的治疗对住院死亡率的性别差异影响不大（比值比1.50，95%可信区间1.38至1.62）。住院死亡率的差异在较年轻患者中更大，年龄＜55岁、55-64岁、65-74岁和≥75岁的校正比值比分别为2.14、1.70、1.48和1.18（趋势p=0.0001）。
与同龄男性相比，STEMI患者入院后女性的死亡率高出约50%，在年龄＜55岁时额外风险尤其高。
