急性冠状动脉综合征患者住院期间管理和结局的性别差异。

Sex Differences in In-Hospital Management and Outcomes of Patients With Acute Coronary Syndrome.

机构信息

Department of Epidemiology, Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, China (Y. Hao, Jing Liu, Jun Liu, N.Y., M.Z, Y.X., D.Z.).

Division of Cardiology, University of North Carolina, Chapel Hill (S.C.S.).

出版信息

Circulation. 2019 Apr 9;139(15):1776-1785. doi: 10.1161/CIRCULATIONAHA.118.037655.

DOI:10.1161/CIRCULATIONAHA.118.037655

PMID:30667281

Abstract

BACKGROUND

Coronary heart disease is a leading cause of mortality among women. Systematic evaluation of the quality of care and outcomes in women hospitalized for acute coronary syndrome (ACS), an acute manifestation of coronary heart disease, remains lacking in China.

METHODS

The CCC-ACS project (Improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome) is an ongoing nationwide registry of the American Heart Association and the Chinese Society of Cardiology. Using data from the CCC-ACS project, we evaluated sex differences in acute management, medical therapies for secondary prevention, and in-hospital mortality in 82 196 patients admitted for ACS at 192 hospitals in China from 2014 to 2018.

RESULTS

Women with ACS were older than men (69.0 versus 61.1 years, P<0.001) and had more comorbidities. After multivariable adjustment, eligible women were less likely to receive evidence-based acute treatments for ACS than men, including early dual antiplatelet therapy, heparins during hospitalization, and reperfusion therapy for ST-segment-elevation myocardial infarction. With respect to strategies for secondary prevention, eligible women were less likely to receive dual antiplatelet therapy, angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, statins at discharge, and smoking cessation and cardiac rehabilitation counseling during hospitalization. In-hospital mortality rate was higher in women than in men (2.60% versus 1.50%, P<0.001). The sex difference in in-hospital mortality was no longer observed in patients with ST-segment-elevation myocardial infarction (adjusted odds ratio, 1.18; 95% CI, 1.00 to 1.41; P=0.057) and non-ST-segment elevation ACS (adjusted odds ratio, 0.84; 95% CI, 0.66 to 1.06; P=0.147) after adjustment for clinical characteristics and acute treatments.

CONCLUSIONS

Women hospitalized for ACS in China received acute treatments and strategies for secondary prevention less frequently than men. The observed sex differences in in-hospital mortality were mainly attributable to worse clinical profiles and fewer evidence-based acute treatments provided to women with ACS. Specially targeted quality improvement programs may be warranted to narrow sex-related disparities in quality of care and outcomes in patients with ACS.

CLINICAL TRIAL REGISTRATION

URL: https://www.clinicaltrials.gov . Unique identifier: NCT02306616.

摘要

背景

冠心病是女性死亡的主要原因。在中国，对因急性冠状动脉综合征（ACS）住院的女性（冠心病的一种急性表现）的护理质量和结局进行系统评估仍存在不足。

方法

CCC-ACS 项目（改善中国心血管疾病护理-急性冠状动脉综合征）是美国心脏协会和中国心脏病学会正在进行的一项全国性注册研究。我们利用 CCC-ACS 项目的数据，评估了 2014 年至 2018 年期间，在中国 192 家医院因 ACS 住院的 82196 例患者中，急性治疗、二级预防药物治疗和院内死亡率方面的性别差异。

结果

ACS 女性患者比男性患者年龄更大（69.0 岁比 61.1 岁，P<0.001），合并症更多。经多变量调整后，与男性相比，符合条件的女性接受 ACS 循证治疗的可能性更小，包括早期双联抗血小板治疗、住院期间使用肝素和 ST 段抬高型心肌梗死再灌注治疗。在二级预防策略方面，与男性相比，符合条件的女性出院时接受双联抗血小板治疗、血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂、他汀类药物治疗、戒烟和住院期间心脏康复咨询的可能性更小。女性院内死亡率高于男性（2.60%比 1.50%，P<0.001）。在 ST 段抬高型心肌梗死（校正比值比，1.18；95%CI，1.00 至 1.41；P=0.057）和非 ST 段抬高型 ACS（校正比值比，0.84；95%CI，0.66 至 1.06；P=0.147）患者中，调整临床特征和急性治疗后，性别与院内死亡率之间的差异不再具有统计学意义。