Cardiology Department, Hospital Prof. Dr. Fernando da Fonseca Hospital, Amadora, Portugal.
Cardiology Department, Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, EPE, Lisbon, Portugal.
Rev Port Cardiol (Engl Ed). 2020 Feb;39(2):57-72. doi: 10.1016/j.repc.2020.03.002. Epub 2020 Mar 20.
Coronary artery disease is becoming the leading cause of death in women in Western society. However, the available data shows that women are still underdiagnosed and undertreated with guideline-recommended secondary prevention therapy, leading to a significantly higher rate of in-hospital complications and in-hospital mortality.
The main objective of this work is to assess the approach to acute coronary syndrome (ACS) in Portugal, including form of presentation, in-hospital treatment and in-hospital complications, according to gender and in three different periods.
We performed an observational study with retrospective analysis of all patients included between 2002 and 2019 in the Portuguese Registry of Acute Coronary Syndromes (ProACS), a voluntary, observational, prospective, continuous registry of the Portuguese Society of Cardiology and the National Center for Data Collection in Cardiology.
A total of 49 113 patients (34 936 men and 14 177 women) were included. Obesity, hypertension, diabetes (p<0.001 for all) and dyslipidemia (p=0.022) were all more prevalent in women, who were more frequently admitted for non-ST segment elevation ACS (p<0.001), and more frequently presented with atypical symptoms. Women had more time until needle and until reperfusion, which is less accessible to this gender (p<0.001). During hospitalization, women had a significantly higher risk of in-hospital mortality (OR 1.94 [1.78-2.12], p<0.001), major bleeding (OR 1.53 [1.30-1.80], p<0.001), heart failure (OR 1.87 [1.78-1.97], p<0.001), atrial fibrillation (OR 1.55 [1.36-1.77], p<0.001), mechanical complications (OR 2.12 [1.78-2.53], p<0.001), cardiogenic shock (OR 1.71 [1.57-1.87], p<0.001) and stroke (OR 2.15 [1.76-2.62], p<0.001). Women were more likely to have a normal coronary angiogram or coronary lesions with <50% luminal stenosis (p<0.001 for both), and thus a final diagnosis other than ACS. Both during hospitalization and at hospital discharge, women were less likely to receive guideline-recommended secondary prevention therapy.
In women admitted for ACS, revascularization strategies are still underused, as is guideline-recommended secondary prevention therapy, which may explain their higher incidence of in-hospital complications and higher unadjusted mortality.
在西方社会，冠心病正成为女性的主要致死病因。然而，现有数据表明，女性仍然存在诊断不足和治疗不足的情况，无法接受指南推荐的二级预防治疗，这导致她们在院内的并发症和死亡率明显更高。
本研究的主要目的是评估葡萄牙急性冠状动脉综合征（ACS）的治疗方法，包括发病形式、院内治疗和院内并发症，并根据性别和三个不同时期进行分析。
我们进行了一项观察性研究，对 2002 年至 2019 年间在葡萄牙急性冠状动脉综合征注册研究（ProACS）中纳入的所有患者进行回顾性分析。该研究是葡萄牙心脏病学会和国家数据采集中心自愿、观察性、前瞻性、连续性注册的研究。
共纳入 49113 例患者（34936 例男性和 14177 例女性）。肥胖症、高血压、糖尿病（均<0.001）和血脂异常（p=0.022）在女性中更为常见，女性更常因非 ST 段抬高型 ACS 入院（p<0.001），且更常出现非典型症状。女性接受针刺和再灌注的时间明显更长，这对女性来说不太方便（均<0.001）。住院期间，女性院内死亡率（OR 1.94 [1.78-2.12]，p<0.001）、大出血（OR 1.53 [1.30-1.80]，p<0.001）、心力衰竭（OR 1.87 [1.78-1.97]，p<0.001）、心房颤动（OR 1.55 [1.36-1.77]，p<0.001）、机械并发症（OR 2.12 [1.78-2.53]，p<0.001）、心源性休克（OR 1.71 [1.57-1.87]，p<0.001）和中风（OR 2.15 [1.76-2.62]，p<0.001）的风险更高。女性更可能有正常的冠状动脉造影或狭窄程度<50%的冠状动脉病变（均<0.001），因此最终诊断并非 ACS。无论是在住院期间还是出院时，女性接受指南推荐的二级预防治疗的可能性均较低。
在因 ACS 入院的女性中，血管重建策略的应用仍然不足，指南推荐的二级预防治疗也不足，这可能解释了她们院内并发症发生率更高和未调整死亡率更高的原因。
