From the Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY (T.G., J.W., A.E.B., R.T.P., M.A.M., M.J.G.); Division of Cardiology, Warren Alpert Medical School, Brown University, Providence, RI (D.K., H.D.A., J.D.A.); Division of Cardiology, Massachusetts General Hospital, Boston (S.K.); Division of Cardiovascular Medicine, University of Florida College of Medicine, Gainesville (N.A.); Division of Cardiology, New York University Langone Medical Center (P.A.V.); Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN (K.G., C.S.R.); Department of Medicine, Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY (K.P.); Division of Cardiology, Westchester Medical Center and New York Medical College, Valhalla (W.S.A., J.A.P.); Division of Cardiology, Ronald Reagan-UCLA Medical Center, Los Angeles, CA (G.C.F.); and Brigham and Women's Hospital Heart & Vascular Center, Harvard Medical School, Boston, MA (D.L.B.).
Circ Cardiovasc Interv. 2018 Jan;11(1):e005735. doi: 10.1161/CIRCINTERVENTIONS.117.005735.
Prior studies have reported higher inhospital mortality in women versus men with non-ST-segment-elevation myocardial infarction. Whether this is because of worse baseline risk profile compared with men or sex-based disparities in treatment is not completely understood.
We queried the 2003 to 2014 National Inpatient Sample databases to identify all hospitalizations in patients aged ≥18 years with the principal diagnosis of non-ST-segment-elevation myocardial infarction. Complex samples multivariable logistic regression models were used to examine sex differences in use of an early invasive strategy and inhospital mortality. Of 4 765 739 patients with non-ST-segment-elevation myocardial infarction, 2 026 285 (42.5%) were women. Women were on average 6 years older than men and had a higher comorbidity burden. Women were less likely to be treated with an early invasive strategy (29.4% versus 39.2%; adjusted odds ratio, 0.92; 95% confidence interval, 0.91-0.94). Women had higher crude inhospital mortality than men (4.7% versus 3.9%; unadjusted odds ratio, 1.22; 95% confidence interval, 1.20-1.25). After adjustment for age (adjusted odds ratio, 0.96; 95% confidence interval, 0.94-0.98) and additionally for comorbidities, other demographics, and hospital characteristics, women had 10% lower odds of inhospital mortality (adjusted odds ratio, 0.90; 95% confidence interval, 0.89-0.92). Further adjustment for differences in the use of an early invasive strategy did not change the association between female sex and lower risk-adjusted inhospital mortality.
Although women were less likely to be treated with an early invasive strategy compared with men, the lower use of an early invasive strategy was not responsible for the higher crude inhospital mortality in women, which could be entirely explained by older age and higher comorbidity burden.
先前的研究报告称，非 ST 段抬高型心肌梗死患者的住院死亡率女性高于男性。这是由于与男性相比，女性的基线风险状况更差，还是由于治疗方面的性别差异尚不完全清楚。
我们查询了 2003 年至 2014 年国家住院患者样本数据库，以确定所有年龄≥18 岁的主要诊断为非 ST 段抬高型心肌梗死患者的住院病例。采用复杂样本多变量逻辑回归模型，考察性别对早期侵入性治疗策略的应用和住院死亡率的影响。在 4765739 例非 ST 段抬高型心肌梗死患者中，2026285 例（42.5%）为女性。女性平均比男性年长 6 岁，且合并症负担更重。女性接受早期侵入性治疗的可能性较低（29.4%对 39.2%；调整后比值比，0.92；95%置信区间，0.91-0.94）。女性的住院死亡率高于男性（4.7%对 3.9%；未调整比值比，1.22；95%置信区间，1.20-1.25）。在校正年龄（调整后比值比，0.96；95%置信区间，0.94-0.98）和合并症、其他人口统计学和医院特征后，女性的住院死亡率降低了 10%（调整后比值比，0.90；95%置信区间，0.89-0.92）。进一步校正早期侵入性治疗策略的应用差异并未改变女性性别与较低风险校正住院死亡率之间的关联。
尽管与男性相比，女性接受早期侵入性治疗的可能性较低，但较低的早期侵入性治疗使用率并不是女性住院死亡率较高的原因，这可以完全用年龄较大和合并症负担较高来解释。
