The Heart Center, Chaim Sheba Medical Center, Tel Hashomer, Sackler School of Medicine, Tel Aviv University, Israel.
The Heart Institute, Rabin Medical Center, Petach-Tikva, Sackler School of Medicine, Tel Aviv University, Israel.
Am J Med. 2017 Nov;130(11):1324.e15-1324.e22. doi: 10.1016/j.amjmed.2017.05.028. Epub 2017 Jun 13.
Young women are usually protected against coronary artery disease due to hormonal and risk-factor profile. Previous studies have suggested poorer outcome in women hospitalized with acute coronary syndrome as compared with men. However, when adjusted for age and other risk factors, this difference does not remain significant. We compared the risk profile and outcome between young (≤55 years) women and men admitted with acute coronary syndrome.
We analyzed clinical characteristics, management strategies, and outcomes of men and women ≤55 years of age enrolled in the biennial Acute Coronary Syndrome Israeli Surveys between 2000 and 2013.
Among 11,536 patients enrolled, 3949 (34%) were ≤55 years old (407 women, 3542 men). Women were slightly older (48.9 ± 5.7 vs 48.3 ± 5.5, P = .007) and suffered more from diabetes (34% vs 24%) and hypertension (47% vs 37%, P <.001 for both). Rates of prior myocardial infarction were high in both sexes (18% vs 21%). Women presented less often with ST-elevation myocardial infarction (50% vs 57%, P = .007) and with typical chest pain (73% vs 80%, P = .004), and had higher rates of Global Registry of Acute Coronary Events (GRACE) score ≥140 (19% vs 12%, P = .007). After adjustment for GRACE score, diabetes, and enrollment year, women had a lower likelihood to undergo coronary angiography during hospitalization (odds ratio 0.6, P = .007). Female sex was independently associated with higher risk of in-hospital mortality (hazard ratio [HR] 4.1; 95% confidence interval [CI], 1.15-14.0), 30-day major adverse cardiac and cerebral events (HR 2.1; 95% CI, 1.31-3.36), and 5-year mortality (HR 1.96; 95% CI, 1.3-2.8).
Young women admitted with acute coronary syndrome are a unique high-risk group that presents a diagnostic challenge for clinicians. Women receive less invasive therapy during hospitalization and have worse in-hospital and long-term outcomes.
由于激素和风险因素的影响，年轻女性通常不易患冠状动脉疾病。先前的研究表明，与男性相比，因急性冠状动脉综合征住院的女性预后较差。然而，当按年龄和其他风险因素调整后，这种差异并不显著。我们比较了≤55 岁的年轻女性和男性因急性冠状动脉综合征住院的风险特征和结局。
我们分析了 2000 年至 2013 年期间每两年进行一次的急性冠状动脉综合征以色列调查中纳入的≤55 岁的男性和女性患者的临床特征、管理策略和结局。
在纳入的 11536 名患者中，3949 名（34%）≤55 岁（407 名女性，3542 名男性）。女性年龄稍大（48.9±5.7 岁 vs. 48.3±5.5 岁，P=0.007），且更易患有糖尿病（34% vs. 24%）和高血压（47% vs. 37%，均 P<0.001）。两种性别均有较高的既往心肌梗死发生率（18% vs. 21%）。女性的 ST 段抬高型心肌梗死发生率较低（50% vs. 57%，P=0.007），且有典型胸痛的比例较低（73% vs. 80%，P=0.004），全球急性冠状动脉事件注册（GRACE）评分≥140 的比例较高（19% vs. 12%，P=0.007）。在调整 GRACE 评分、糖尿病和入组年份后，女性在住院期间进行冠状动脉造影的可能性较低（比值比 0.6，P=0.007）。女性性别与住院期间死亡率升高（危险比 [HR] 4.1；95%置信区间 [CI]，1.15-14.0）、30 天主要不良心脑血管事件（HR 2.1；95%CI，1.31-3.36）和 5 年死亡率（HR 1.96；95%CI，1.3-2.8）独立相关。
因急性冠状动脉综合征住院的年轻女性是一个独特的高危人群，给临床医生带来了诊断挑战。女性在住院期间接受的侵入性治疗较少，且住院期间和长期预后较差。
