Dittrich H, Gilpin E, Nicod P, Cali G, Henning H, Ross J
Cardiology Division, UCSD Medical Center, California 92103.
Am J Cardiol. 1988 Jul 1;62(1):1-7. doi: 10.1016/0002-9149(88)91356-2.
The contention that mortality after acute myocardial infarction (AMI) is increased in women compared with men has been controversial, with findings in a recent multicenter study suggesting that gender plays an important prognostic role. To assess whether or not early and late mortality after AMI is greater in women, 2,089 patients (1,551 men, 538 women) were followed for 1 year after AMI. In the hospital, women had an increased mortality compared to men (17.5 vs 12.3%, p less than 0.003) and were on average 7 years older, whereas after hospital discharge and up to 1 year no difference in mortality was observed. Multivariate analyses of historical, clinical and laboratory features demonstrated that gender had no independent predictive value when variables that included age, congestive heart failure in the hospital, history of congestive failure, prior AMI and diabetes mellitus were considered. Moreover, when age stratification was performed, the significant difference of in-hospital mortality between genders was no longer present. Causes of death in the hospital and during 1 year after hospital discharge were similar between men and women, whether or not age stratification was performed. Several baseline clinical characteristics were different between men and women; a history of systemic hypertension and congestive heart failure occurred more frequently in women and previous AMI and smoking occurred more commonly in men. Also, the value of several other important prognostic indicators after AMI, such as the ejection fraction, was found to differ between men and women.(ABSTRACT TRUNCATED AT 250 WORDS)
与男性相比，急性心肌梗死（AMI）后女性死亡率升高这一观点一直存在争议，最近一项多中心研究的结果表明性别起着重要的预后作用。为评估AMI后女性的早期和晚期死亡率是否更高，对2089例患者（1551例男性，538例女性）在AMI后进行了1年的随访。在医院里，女性死亡率高于男性（17.5%对12.3%，p<0.003），且平均年龄大7岁，而出院后至1年未观察到死亡率差异。对病史、临床和实验室特征进行多变量分析表明，当考虑年龄、住院时的充血性心力衰竭、充血性心力衰竭病史、既往AMI和糖尿病等变量时，性别没有独立的预测价值。此外，进行年龄分层时，性别间住院死亡率的显著差异不再存在。无论是否进行年龄分层，男性和女性在医院及出院后1年内的死亡原因相似。男性和女性的几个基线临床特征不同；系统性高血压和充血性心力衰竭病史在女性中更常见，既往AMI和吸烟在男性中更常见。此外，还发现AMI后其他几个重要预后指标的值，如射血分数，在男性和女性之间存在差异。（摘要截短于250字）
