Matetic Andrija, Shamkhani Warkaa, Rashid Muhammad, Volgman Annabelle Santos, Van Spall Harriette G C, Coutinho Thais, Mehta Laxmi S, Sharma Garima, Parwani Purvi, Mohamed Mohamed Osama, Mamas Mamas A
Department of Cardiology, University Hospital of Split, Split, Croatia.
Department of Pathophysiology, University of Split School of Medicine, Split, Croatia.
CJC Open. 2021 Jul 1;3(12 Suppl):S19-S27. doi: 10.1016/j.cjco.2021.06.012. eCollection 2021 Dec.
Female patients have been shown to experience worse clinical outcomes after acute myocardial infarction (AMI) compared with male patients. However, it is unclear what trend these differences followed over time.
Data from patients hospitalized with AMI between 2004 and 2015 in the National Inpatient Sample were retrospectively analyzed, stratified according to sex. Multivariable logistic regression analyses were performed to examine the adjusted odds ratios (aORs) of invasive management and in-hospital outcomes according to sex. The Mantel-Haenszel extension of the χ test was performed to examine the trend of management and in-hospital outcomes over the study period.
Of 7,026,432 AMI hospitalizations, 39.7% (n = 2,789,494) were women. Overall, women were older (median: 77 vs 70 years), with a higher prevalence of risk factors such as diabetes, hypertension, and depression. Women were less likely to receive coronary angiography (aOR, 0.92; 95% confidence interval [CI], 0.91-0.93) and percutaneous coronary intervention (aOR, 0.82; 95% CI, 0.81-0.83) compared with men. Odds of all-cause mortality were higher in women (aOR, 1.03; 95% CI, 1.02-1.04; < 0.001) and these rates have not narrowed over time (2004 vs 2015: aOR, 1.07 [95% CI, 1.04-1.09] vs 1.11 [95% CI, 1.07-1.15), with similar observations recorded for major adverse cardiovascular and cerebrovascular events.
In this temporal analysis of AMI hospitalizations over 12 years, we showed lower receipt of invasive therapies and higher mortality rates in women, with no change in temporal trends. There needs to be a systematic and consistent effort toward exploring these disparities to identify strategies to mitigate them.
与男性患者相比，女性患者在急性心肌梗死（AMI）后临床结局更差。然而，目前尚不清楚这些差异随时间推移呈现何种趋势。
对2004年至2015年期间因AMI住院的患者数据进行回顾性分析，数据来自国家住院患者样本，并按性别分层。进行多变量逻辑回归分析，以检验根据性别进行侵入性治疗和住院结局的调整比值比（aORs）。采用χ检验的Mantel-Haenszel扩展法，以检验研究期间治疗和住院结局的趋势。
在7,026,432例AMI住院患者中，39.7%（n = 2,789,494）为女性。总体而言，女性年龄更大（中位数：77岁对70岁），糖尿病、高血压和抑郁症等危险因素的患病率更高。与男性相比，女性接受冠状动脉造影（aOR，0.92；95%置信区间[CI]，0.91 - 0.93）和经皮冠状动脉介入治疗（aOR，0.82；95% CI，0.81 - 0.83）的可能性更低。女性全因死亡率的比值比更高（aOR，1.03；95% CI，1.02 - 1.04；P < 0.001），且这些比率随时间并未缩小（2004年对2015年：aOR，1.07 [95% CI，1.04 - 1.09]对1.11 [95% CI，1.07 - 1.15]），主要心血管和脑血管不良事件的情况也类似。
在对12年期间AMI住院患者的此项时间分析中，我们发现女性接受侵入性治疗的比例较低且死亡率较高，时间趋势未发生变化。需要做出系统且持续的努力来探究这些差异，以确定减轻差异的策略。
