1 School of Biomedical Informatics, University of Texas Health Science Center , Houston, Texas.
2 Cedars-Sinai Heart Institute , Los Angeles, California.
J Womens Health (Larchmt). 2018 Aug;27(8):1001-1006. doi: 10.1089/jwh.2017.6553. Epub 2018 Jan 10.
It is known that women with ST-segment elevation myocardial infarction (STEMI) have higher mortality in comparison to men. While the reasons for this sex-based difference are not completely understood, biologic differences and disparities in care have been implicated. Whether these differences persist within an urban, regional STEMI system of care with defined protocols is unclear. Our objective was to explore sex-related effects in outcomes in a large regional system of care.
Data were drawn from a regional subset of the National Cardiovascular Data Registry for 33 hospitals in and around Dallas County, Texas from 2010 to 2015. We explored adjusted differences between women and men for discharge disposition, door to balloon (D2B), total ischemic time (TIS), length of stay, and in-hospital mortality rates.
Multivariate regressions to control for confounding factors, including age, D2B, and TIS, were significantly prolonged in women compared to men (D2B 58 vs. 54 minutes; TIS 206 vs. 178 minutes; both p < 0.001). Length of stay was 0.45 median days longer. Women were also much less likely to survive at discharge than men [odds ratio (OR): 0.63; 95% confidence interval (CI): 0.52-0.76]. Most notably, they were much less likely to be discharged to home than men (88% vs. 92%, p < 0.001).
In this study, we found that sex-based disparities persist for both cardiovascular outcomes and discharge disposition, even in a modern regionalized system of care.
已知女性 ST 段抬高型心肌梗死（STEMI）患者的死亡率高于男性。尽管造成这种性别差异的原因尚未完全明确，但生物学差异和护理差异已被牵涉其中。在一个具有明确治疗方案的城市区域性 STEMI 治疗系统中，这些差异是否仍然存在尚不清楚。我们的目的是在一个大型区域性治疗系统中探究与性别相关的结局差异。
数据来自 2010 年至 2015 年期间德克萨斯州达拉斯县及其周边 33 家医院的国家心血管数据注册中心的区域性子集。我们探讨了女性和男性在出院去向、门球时间（D2B）、总缺血时间（TIS）、住院时间和院内死亡率方面的调整后差异。
多元回归分析以控制混杂因素，包括年龄、D2B 和 TIS，结果显示女性的 D2B 和 TIS 明显长于男性（D2B：58 分钟比 54 分钟；TIS：206 分钟比 178 分钟；均 p<0.001）。住院时间中位数长 0.45 天。女性出院时的存活率也明显低于男性[比值比（OR）：0.63；95%置信区间（CI）：0.52-0.76]。最值得注意的是，她们出院后回家的可能性明显低于男性（88%比 92%，p<0.001）。
在这项研究中，我们发现即使在现代区域性治疗系统中，性别差异在心血管结局和出院去向方面仍然存在。
