中国非 ST 段抬高型心肌梗死住院患者的特征、治疗和结局的性别差异：2006 年至 2015 年。
Sex Differences in Characteristics, Treatments, and Outcomes Among Patients Hospitalized for Non-ST-Segment-Elevation Myocardial Infarction in China: 2006 to 2015.
机构信息
National Clinical Research Center for Cardiovascular Diseases, NHC Key Laboratory of Clinical Research for Cardiovascular Medications, State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, National Center for Cardiovascular Diseases, Beijing, China (W.G., X.D., Y.G., S.H., X.L., X.Z.).
Center for Outcomes Research and Evaluation, Yale New Haven Hospital, New Haven, CT (Y.L., R.P.D., E.S.S., H.M.K.).
出版信息
Circ Cardiovasc Qual Outcomes. 2022 Jun;15(6):e008535. doi: 10.1161/CIRCOUTCOMES.121.008535. Epub 2022 May 24.
BACKGROUND
Sex differences in clinical characteristics and in-hospital outcomes among patients with non-ST-segment-elevation myocardial infarction have been described in Western countries, but whether these differences exist in China is unknown.
METHODS
We used a 2-stage random sampling design to create a nationally representative sample of patients admitted to 151 Chinese hospitals for non-ST-segment-elevation myocardial infarction in 2006, 2011, and 2015 and examined sex differences in clinical profiles, treatments, and in-hospital outcomes over this time. Multivariable logistic regression models adjusting for age or other potentially confounding clinical covariates were used to estimate these sex-specific differences.
RESULTS
Among 4611 patients, the proportion of women (39.8%) was unchanged between 2006 and 2015. Women were older with higher rates of hypertension, diabetes, and dyslipidemia. Among patients without contraindications, women were less likely to receive treatments than men, with significant differences for aspirin in 2015 (90.3% versus 93.9%) and for invasive strategy in 2011 (28.7% versus 45.7%) and 2015 (34.0% versus 48.4%). After adjusting for age, such differences in aspirin and invasive strategy in 2015 were not significant, but the difference in invasive strategy in 2011 persisted. The sex gaps in the use of invasive strategy did not narrow. From 2006 to 2015, a significant decrease in in-hospital mortality was observed in men (from 16.9% to 8.7%), but not in women (from 11.8% to 12.0%), with significant interaction between sex and study year (=0.023). After adjustment, in-hospital mortality in women was significantly lower than men in 2006, but not in 2011 or 2015.
CONCLUSIONS
Sex differences in cardiovascular risk factors and invasive strategy after non-ST-segment-elevation myocardial infarction were observed between 2011 and 2015 in China. Although sex gaps in in-hospital mortality were largely explained by age differences, efforts to narrow sex-related disparities in quality of care should remain a focus.
REGISTRATION
URL: http://www.
CLINICALTRIALS
gov; Unique identifier: NCT01624883.
背景
在西方国家，非 ST 段抬高型心肌梗死患者的临床特征和住院结局存在性别差异，但在中国是否存在这些差异尚不清楚。
方法
我们使用两阶段随机抽样设计，创建了一个 2006 年、2011 年和 2015 年在中国 151 家医院因非 ST 段抬高型心肌梗死住院的具有全国代表性的患者样本，并在此期间检查了临床特征、治疗和住院结局方面的性别差异。使用多变量逻辑回归模型，根据年龄或其他潜在混杂的临床协变量进行调整，以估计这些性别特异性差异。
结果
在 4611 名患者中，女性（39.8%）的比例在 2006 年至 2015 年期间保持不变。女性年龄较大，高血压、糖尿病和血脂异常的发生率较高。在没有禁忌症的患者中，与男性相比，女性接受治疗的可能性较小，2015 年阿司匹林（90.3%对 93.9%）和 2011 年和 2015 年的侵入性策略（28.7%对 45.7%和 34.0%对 48.4%）存在显著差异。调整年龄后，2015 年阿司匹林和侵入性策略的差异不再显著，但 2011 年的侵入性策略差异仍然存在。侵入性策略使用方面的性别差距并未缩小。从 2006 年到 2015 年，男性住院死亡率显著下降（从 16.9%降至 8.7%），但女性（从 11.8%降至 12.0%）没有显著变化，性别和研究年份之间存在显著交互作用（=0.023）。调整后，2006 年女性住院死亡率明显低于男性，但 2011 年和 2015 年并非如此。
结论
在中国，2011 年至 2015 年间，非 ST 段抬高型心肌梗死患者的心血管危险因素和介入策略存在性别差异。尽管住院死亡率的性别差异在很大程度上可以用年龄差异来解释，但缩小护理质量相关性别差距的工作仍应是重点。
登记
网址：http://www.
临床试验
gov；独特标识符：NCT01624883.
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