British Heart Foundation Glasgow Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, University Place, Glasgow G12 8TA, UK.
Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow, Boyd Orr Building, University Avenue, Glasgow G12 8QQ, UK.
Eur Heart J Qual Care Clin Outcomes. 2020 Apr 1;6(2):156-165. doi: 10.1093/ehjqcco/qcz040.
Ischaemic heart disease persists as the leading cause of death in both men and women in most countries and sex disparities, defined as differences in health outcomes and their determinants, may be relevant. We examined sex disparities in presenting characteristics, treatment and all-cause mortality in patients hospitalized with myocardial infarction (MI) or angina.
We conducted a cohort study of all patients admitted with MI or angina (01 October 2013 to 30 June 2016) from a secondary care acute coronary syndrome e-Registry in NHS Scotland linked with national registers of community drug dispensation and mortality data. A total of 7878 patients hospitalized for MI or angina were prospectively included; 3161 (40%) were women. Women were older, more deprived, had a greater burden of comorbidity, were more often treated with guideline-recommended therapy preadmission and less frequently received immediate invasive management. Men were more likely to receive coronary angiography [adjusted odds ratio (OR) 1.52, confidence interval (CI) 1.37-1.68] and percutaneous coronary intervention (adjusted OR 1.68, CI 1.52-1.86). Women were less comprehensively treated with evidence-based therapies post-MI. Women had worse crude survival, primarily those with ST-elevation myocardial infarction (14.3% vs. 8.0% at 1 year, P < 0.001), but this finding was explained by differences in baseline factors. Men with non-ST-elevation myocardial infarction had a higher risk of all-cause death at 30 days [adjusted hazard ratio (HR) 1.72, CI 1.16-2.56] and 1 year (adjusted HR 1.38, CI 1.12-1.69).
After taking account of baseline risk factors, sex differences in treatment pathway, use of invasive management, and secondary prevention therapies indicate disparities in guideline-directed management of women hospitalized with MI or angina.
在大多数国家，缺血性心脏病仍然是男性和女性的主要死因，性别差异（定义为健康结果及其决定因素的差异）可能相关。我们研究了因心肌梗死（MI）或心绞痛住院的患者在表现特征、治疗和全因死亡率方面的性别差异。
我们对苏格兰国民保健系统中二级保健急性冠状动脉综合征电子注册处（2013 年 10 月 1 日至 2016 年 6 月 30 日）收录的所有因 MI 或心绞痛住院的患者进行了队列研究，该注册处与社区药物配给和死亡率国家登记处相关联。共前瞻性纳入 7878 例因 MI 或心绞痛住院的患者；其中 3161 例（40%）为女性。女性年龄较大、贫困程度较高、合并症负担较重，入院前更常接受指南推荐的治疗，较少接受立即侵入性治疗。男性更可能接受冠状动脉造影[校正优势比（OR）1.52，置信区间（CI）1.37-1.68]和经皮冠状动脉介入治疗（校正 OR 1.68，CI 1.52-1.86）。女性在 MI 后接受基于证据的治疗更为全面。女性的总体生存率较差，尤其是 ST 段抬高型心肌梗死患者（1 年时分别为 14.3%和 8.0%，P<0.001），但这一发现是由基线因素差异导致的。非 ST 段抬高型心肌梗死患者在 30 天[校正风险比（HR）1.72，CI 1.16-2.56]和 1 年（校正 HR 1.38，CI 1.12-1.69）时的全因死亡风险更高。
在考虑到基线风险因素后，治疗途径、使用侵入性治疗和二级预防治疗方面的性别差异表明，因 MI 或心绞痛住院的女性在指南指导的管理方面存在差异。
