心血管疾病治疗的差异：一项基于澳大利亚队列研究的关于接受冠状动脉介入治疗的性别差异。
Variation in cardiovascular disease care: an Australian cohort study on sex differences in receipt of coronary procedures.
机构信息
Australian National University Medical School, The Australian National University, Canberra, Australian Capital Territory, Australia.
National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia.
出版信息
BMJ Open. 2019 Jul 23;9(7):e026507. doi: 10.1136/bmjopen-2018-026507.
OBJECTIVES
The aim of this study was to quantify sex differences in diagnostic and revascularisation coronary procedures within 1 year of hospitalisation for acute myocardial infarction (AMI) or angina.
DESIGN
This is a prospective cohort study. Baseline questionnaire (January 2006-April 2009) data from the Sax Institute's 45 and Up Study were linked to hospitalisation and mortality data (to 30 June 2016) in a time-to-event analysis, treating death as a censoring event.
SETTING
This was conducted in New South Wales, Australia.
PARTICIPANTS
The study included participants aged ≥45 years with no history of ischaemic heart disease (IHD) who were admitted to hospital with a primary diagnosis of AMI (n=4580) or a primary diagnosis of angina or chronic IHD with secondary diagnosis of angina (n=4457).
OUTCOME MEASURES
The outcome of this study was coronary angiography and coronary revascularisation with percutaneous coronary intervention or coronary artery bypass graft (PCI/CABG) within 1 year of index admission. Cox regression models compared coronary procedure rates in men and women, adjusting sequentially for age, sociodemographic variables and health characteristics.
RESULTS
Among patients with AMI, 71.6% of men (crude rate 3.45/person-year) and 64.7% of women (2.62/person-year) received angiography; 57.8% of men (1.73/person-year) and 37.4% of women (0.77/person-year) received PCI/CABG. Adjusted HRs for men versus women were 1.00 (0.92-1.08) for angiography and 1.51 (1.38-1.67) for PCI/CABG. In the angina group, 67.3% of men (crude rate 2.36/person-year) and 54.9% of women (1.32/person-year) received angiography; 44.6% of men (0.90/person-year) and 19.5% of women (0.26/person-year) received PCI/CABG. Adjusted HRs were 1.24 (1.14-1.34) and 2.44 (2.16-2.75), respectively.
CONCLUSIONS
Men are more likely than women to receive coronary procedures, particularly revascularisation. This difference is most evident among people with angina, where clinical guidelines are less prescriptive than for AMI.
目的
本研究旨在定量分析急性心肌梗死（AMI）或心绞痛住院后 1 年内男女之间在诊断和血运重建冠状动脉治疗方面的差异。
设计
这是一项前瞻性队列研究。利用 Sax 研究所的 45 岁及以上人群研究的基线问卷（2006 年 1 月至 2009 年 4 月）数据，采用时间事件分析（将死亡视为删失事件），将住院和死亡率数据（截至 2016 年 6 月 30 日）进行关联。
地点
在澳大利亚新南威尔士州进行。
参与者
研究纳入了年龄≥45 岁、无缺血性心脏病（IHD）病史的患者，这些患者因 AMI（n=4580）或心绞痛或慢性 IHD 合并次要诊断为心绞痛（n=4457）而住院，被诊断为 AMI 或心绞痛或慢性 IHD 合并次要诊断为心绞痛。
主要结局指标
本研究的结局是在指数住院后 1 年内进行冠状动脉造影和经皮冠状动脉介入或冠状动脉旁路移植术（PCI/CABG）。Cox 回归模型比较了男性和女性的冠状动脉治疗率，按年龄、社会人口统计学变量和健康特征依次进行调整。
结果
在 AMI 患者中，71.6%的男性（粗率为 3.45/人年）和 64.7%的女性（2.62/人年）接受了血管造影；57.8%的男性（1.73/人年）和 37.4%的女性（0.77/人年）接受了 PCI/CABG。男性与女性相比，血管造影的调整后 HR 为 1.00（0.92-1.08），PCI/CABG 的调整后 HR 为 1.51（1.38-1.67）。在心绞痛患者中，67.3%的男性（粗率为 2.36/人年）和 54.9%的女性（1.32/人年）接受了血管造影；44.6%的男性（0.90/人年）和 19.5%的女性（0.26/人年）接受了 PCI/CABG。调整后的 HR 分别为 1.24（1.14-1.34）和 2.44（2.16-2.75）。
结论
与女性相比，男性更有可能接受冠状动脉治疗，尤其是血运重建治疗。这种差异在心绞痛患者中最为明显，因为临床指南对心绞痛的规定不如 AMI 那么明确。
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