Monash University, Faculty of Medicine, Nursing and Health Sciences, Melbourne, Vic, Australia.
Department of Cardiology, Alfred Hospital, Melbourne, Vic, Australia; Centre of Cardiovascular Research and Education in Therapeutics, Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Vic, Australia.
Heart Lung Circ. 2021 Jan;30(1):18-26. doi: 10.1016/j.hlc.2020.06.025. Epub 2020 Aug 27.
Women have generally worse outcomes after myocardial infarction (MI) compared to men. The reasons for these disparities are multifactorial. At the beginning is the notion-widespread in the community and health care providers-that women are at low risk for MI. This can impact on primary prevention of cardiovascular disease in women, with lower use of preventative therapies and lifestyle counselling. It can also lead to delays in presentation in the event of an acute MI, both at the patient and health care provider level. This is of particular concern in the case of ST elevation MI (STEMI), where "time is muscle". Even after first medical contact, women with acute MI experience delays to diagnosis with less timely reperfusion and percutaneous coronary intervention (PCI). Compared to men, women are less likely to undergo invasive diagnostic testing or PCI. After being diagnosed with a STEMI, women receive less guideline-directed medical therapy and potent antiplatelets than men. The consequences of these discrepancies are significant-with higher mortality, major cardiovascular events and bleeding after MI in women compared to men. We review the sex disparities in pathophysiology, risk factors, presentation, diagnosis, treatment, and outcomes for acute MI, to answer the question: are they due to biology or bias, or both?
女性在心肌梗死 (MI) 后的结局通常比男性差。造成这些差异的原因是多方面的。首先，有一种观念在社区和医疗保健提供者中广泛存在，即女性患 MI 的风险较低。这可能会影响女性心血管疾病的一级预防，预防性治疗和生活方式咨询的使用率较低。这也可能导致急性 MI 发作时的就诊延迟，无论是在患者还是医疗保健提供者层面。在 ST 段抬高型心肌梗死 (STEMI) 的情况下，情况尤其如此，因为“时间就是心肌”。即使在首次医疗接触后，女性急性 MI 患者的诊断也会延迟，再灌注和经皮冠状动脉介入治疗 (PCI) 的时间也更不及时。与男性相比，女性不太可能接受有创性诊断性检查或 PCI。女性在诊断为 STEMI 后，接受的指南指导的药物治疗和强效抗血小板药物治疗也比男性少。这些差异的后果是显著的——与男性相比，女性的死亡率、主要心血管事件和 MI 后的出血率更高。我们回顾了急性 MI 的病理生理学、危险因素、表现、诊断、治疗和结局方面的性别差异，以回答以下问题：这些差异是由生物学因素还是偏见造成的，或者两者皆有？
