Cardiology Department Rabin Medical Center Petah Tikva Israel.
Sackler Faculty of Medicine Tel Aviv University Tel Aviv Israel.
J Am Heart Assoc. 2020 Jan 7;9(1):e014721. doi: 10.1161/JAHA.119.014721. Epub 2019 Dec 19.
Background Cardiovascular disease remains a leading cause of death among women. Despite improvements in the management of patients with acute coronary syndrome (ACS), women with an ACS remain at higher risk. Methods and Results We performed a time-dependent analysis of the management and outcomes of women admitted with ACS who enrolled in the prospective biennial ACS Israeli Surveys between 2000 and 2016. Surveys were divided into 3 time periods (2000-2004, 2006-2010, and 2013-2016). Outcomes included 30-day major adverse cardiac events (death, myocardial infarction, stroke, unstable angina, stent thrombosis, urgent revascularization) and 1-year mortality. Overall, 3518 women were admitted with an ACS. Their mean age (70±12 years) was similar among the time periods. Over the time course of the study, more women were admitted with non-ST-elevation ACS (51.9%, 59.6%, and 66.1%, respectively; <0.001), and statins and percutaneous coronary intervention were increasingly utilized (66%, 91%, 93%, and 42%, 60%, and 68%, respectively; <0.001 for each). Among women with ST-segment-elevation myocardial infarction, more primary percutaneous coronary interventions were performed (48.5%, 84.7%, and 95.3%, respectively; <0.001). The rate of 30-day major adverse cardiac events has significantly decreased over the years (24.6%, 18.6%, and 13.5%, respectively; <0.001). However, 1-year mortality rates declined only from 2000 to 2004 (16.9%, 12.8%, and 12.3%; =0.007 for the overall difference), and this change was not significant after propensity matching or multivariate analysis. Conclusions Over more than a decade, 30-day major adverse cardiac events have decreased among women with ACS. Advances in pharmacological treatments and an early invasive approach may have accounted for this improvement. However, the lack of further reduction in 1-year mortality rates among women suggests that more measures should be provided in this high-risk population.
心血管疾病仍然是女性死亡的主要原因。尽管急性冠状动脉综合征（ACS）患者的管理得到了改善，但 ACS 女性的风险仍然较高。
我们对 2000 年至 2016 年期间参加前瞻性每两年一次 ACS 以色列调查的 ACS 女性患者的管理和结局进行了时间依赖性分析。调查分为 3 个时期（2000-2004 年、2006-2010 年和 2013-2016 年）。结局包括 30 天主要不良心脏事件（死亡、心肌梗死、卒 中、不稳定型心绞痛、支架血栓形成、紧急血运重建）和 1 年死亡率。总体而言，3518 名女性因 ACS 入院。她们的平均年龄（70±12 岁）在各时期相似。在研究过程中，越来越多的女性因非 ST 段抬高型 ACS 入院（分别为 51.9%、59.6%和 66.1%；<0.001），并越来越多地使用他汀类药物和经皮冠状动脉介入治疗（分别为 66%、91%、93%和 42%、60%和 68%；每个均<0.001）。在 ST 段抬高型心肌梗死患者中，更多地进行了直接经皮冠状动脉介入治疗（分别为 48.5%、84.7%和 95.3%；<0.001）。多年来，30 天主要不良心脏事件的发生率显著下降（分别为 24.6%、18.6%和 13.5%；<0.001）。然而，1 年死亡率仅从 2000 年至 2004 年下降（分别为 16.9%、12.8%和 12.3%；整体差异的=0.007），并且在倾向匹配或多变量分析后，这种变化并不显著。
十多年来，ACS 女性的 30 天主要不良心脏事件有所减少。药物治疗和早期介入治疗方法的进步可能是这种改善的原因。然而，ACS 女性 1 年死亡率没有进一步降低表明，高危人群应采取更多措施。
