Novak Katarina, Vrdoljak Davorka, Jelaska Igor, Borovac Josip Anđelo
Department of Internal Medicine, Division of Cardiology, University of Split Clinical Hospital Center, Spinčićeva 1, 21000, Split, Croatia.
Department of Family Medicine, University of Split School of Medicine (USSM), Šoltanska 2, 21000, Split, Croatia.
Wien Klin Wochenschr. 2017 Apr;129(7-8):233-242. doi: 10.1007/s00508-016-1105-7. Epub 2016 Oct 25.
The goal of this observational cohort study was to examine gender-specific differences in the incidence of acute coronary syndrome (ACS), in-hospital complications and mortality.
A cohort of 1550 patients with the primary diagnosis of ACS were enrolled in the study over a period of 4 years. The in-hospital mortality and complications were analyzed as the main outcome measures.
Women were significantly older compared to men (71 ± 11 years vs. 64 ± 12 years, p < 0.001) and had higher in-hospital mortality and complications due to this age difference. The prevalence of smoking was lower while hypertension and history of angina pectoris was more frequent in women, independent of age. Percutaneous transluminal coronary angioplasty (PTCA) with or without stenting as well as coronary catheterization significantly reduced in-hospital mortality and complications while thrombolytic therapy was associated with a 3.3 times increased mortality odds ratio (OR, p = 0.01). Other significant predictors of in-hospital mortality were in-hospital complications (OR 25, p < 0.001) and ST segment elevation myocardial infarction (STEMI, OR 4.5, p < 0.001).
Women differed from men in terms of ACS clinical characteristics, treatment, invasive procedures and survival outcome and some of these effects were age-related. The future emphasis should be based on the prevention of modifiable risk factors and identification of subgroups of female patients that could benefit from more aggressive therapeutic strategies.
这项观察性队列研究的目的是探讨急性冠状动脉综合征（ACS）发病率、院内并发症及死亡率的性别差异。
在4年期间，纳入1550例初步诊断为ACS的患者组成队列。分析院内死亡率和并发症作为主要结局指标。
女性患者年龄显著大于男性（71±11岁 vs. 64±12岁，p<0.001），由于这种年龄差异，女性的院内死亡率和并发症更高。与年龄无关，女性吸烟率较低，而高血压和心绞痛病史更为常见。无论是否置入支架的经皮腔内冠状动脉成形术（PTCA）以及冠状动脉导管插入术显著降低了院内死亡率和并发症，而溶栓治疗与死亡率比值比（OR）增加3.3倍相关（p=0.01）。院内死亡的其他显著预测因素是院内并发症（OR 25，p<0.001）和ST段抬高型心肌梗死（STEMI，OR 4.5，p<0.001）。
女性在ACS临床特征、治疗、侵入性操作及生存结局方面与男性不同，其中一些影响与年龄有关。未来应重点预防可改变的危险因素，并识别可能从更积极治疗策略中获益的女性患者亚组。
