Division of Cardiovascular Medicine, Department of Medicine, State University of New York, Stony Brook, NY, USA.
Health Sciences Center T16-080, Stony Brook University Medical Center, Stony Brook, NY, 11794, USA.
Curr Cardiol Rep. 2018 Jun 16;20(8):64. doi: 10.1007/s11886-018-1006-7.
This review provides updates in gender disparities in the symptom profile, risk factors, quality and timeliness of guideline-based medical care, and clinical outcomes, including mortality, bleeding, and vascular complications, in patients with acute myocardial infarction (AMI).
While AMI continues to be a leading cause of mortality in both men and women, significant gender differences exist in presentation, management, and outcomes. Women with AMI are older, suffer atypical symptoms, and more often present with HF and cardiogenic shock. Delays in medical care and hence longer ischemic times exist in women, partly due to decreased awareness and lack of symptom recognition. Women continue to be less likely to receive guideline-based pharmacological therapies and revascularization than men with AMI. While women suffer from significantly higher risk-adjusted rates of bleeding, vascular complications, and short-term mortality, the risk-adjusted rates of long-term mortality remain similar between men and women. Further investigations and efforts are needed to aggressively modify risk factors, reduce delays in care, and address the higher rates of adverse events seen in women with AMI. Significant sex disparities are prevalent in presentation, management, and outcomes of adults with AMI. Further investigations and efforts are needed to aggressively modify risk factors, reduce delays in care, and address the higher rates of adverse events seen in women with AMI.
本文综述了急性心肌梗死(AMI)患者在症状谱、危险因素、基于指南的医疗质量和及时性以及临床结局(包括死亡率、出血和血管并发症)方面的性别差异的最新研究进展。
尽管 AMI 仍然是男性和女性的主要死亡原因,但在表现、管理和结局方面仍存在显著的性别差异。AMI 女性患者年龄更大,症状不典型,更常出现心力衰竭和心源性休克。女性的医疗护理延迟时间更长,导致缺血时间延长,部分原因是女性的意识降低和缺乏症状识别。与男性 AMI 患者相比,女性接受基于指南的药物治疗和血运重建的可能性更低。尽管女性发生出血、血管并发症和短期死亡率的风险调整后发生率明显更高,但男性和女性的长期死亡率风险调整后发生率相似。需要进一步调查和努力,积极调整危险因素,减少护理延迟,并解决 AMI 女性患者中更高的不良事件发生率。在 AMI 成人的表现、管理和结局方面存在明显的性别差异。需要进一步调查和努力,积极调整危险因素,减少护理延迟,并解决 AMI 女性患者中更高的不良事件发生率。