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性别差异对急性冠状动脉综合征患者治疗延迟、管理和死亡率的影响：系统评价和荟萃分析。

Gender Differences in Treatment Delays, Management and Mortality among Patients with Acute Coronary Syndrome: A Systematic Review and Meta-analysis.

机构信息

Horbachevsky Ternopil National Medical University, Ternopil, Ukraine.

出版信息

Curr Cardiol Rev. 2023;19(1):e300622206530. doi: 10.2174/1573403X18666220630120259.

DOI:10.2174/1573403X18666220630120259
PMID:35786190
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10201882/
Abstract

BACKGROUND

We aimed to provide a comprehensive overview of existing gender differences in acute coronary syndrome (ACS), with respect to treatment delays, invasive management of ACS, and short and long-term mortality in patients with ACS.

METHODS

We defined 37 observational studies (OSs) and 21 randomized trials (RCTs) that best corresponded to our interests. OSs and RCTs were analyzed separately.

RESULTS

Women with ACS more often experienced delays in treatment compared to men (OR 1.43; 95% CI, 1.12-1.82) in RCTs. Female patients were less often treated invasively: RCTs (OR 0.87; 95% CI, 0.83-0.9), OSs: (OR 0.66; 95% CI, 0.63-0.68). Women had higher crude in-hospital mortality (OR 1.56; 95% CI, 1.53-1.59) and 30-day mortality (OR 1.71; 95% CI, 1.22-2.4) in OSs and (OR 2.74; 95% CI, 2.48-3.02) in RCTs. After adjustment for multiple covariates, gender difference was attenuated: in-hospital mortality (OR 1.19; 95% CI, 1.17-1.2), 30-day mortality (OR 1.18; 95% CI, 1.12-1.24) in OSs. Unadjusted long-term mortality in women was higher than in men (OR 1.41; 95% CI, 1.31-1.52) in RCTs and (OR 1.4; 95% CI, 1.3-1.5) in OSs.

CONCLUSION

Women with ACS experience a delay in time to treatment more often than men. They are also less likely to be treated invasively. Females have shown worse crude short-and long-term all-cause mortality compared to males. However, after adjustment for multiple covariates, a less significant gender difference has been observed. Considering the difference between crude and adjusted mortality, we deem it reasonable to conduct further investigations on gender-related influence of particular risk factors on the outcomes of ACS.

摘要

背景

本研究旨在全面概述急性冠状动脉综合征（ACS）中现有的性别差异，包括治疗延迟、ACS 的有创治疗以及 ACS 患者的短期和长期死亡率。

方法

我们定义了 37 项观察性研究（OS）和 21 项随机试验（RCT），这些研究最符合我们的研究兴趣。分别对 OS 和 RCT 进行了分析。

结果

在 RCT 中，与男性相比，ACS 女性患者的治疗延迟更为常见（OR 1.43；95%CI，1.12-1.82）。女性患者接受有创治疗的可能性较小：RCT（OR 0.87；95%CI，0.83-0.9），OS（OR 0.66；95%CI，0.63-0.68）。OS 中，女性患者的住院死亡率（OR 1.56；95%CI，1.53-1.59）和 30 天死亡率（OR 1.71；95%CI，1.22-2.4）更高，RCT 中，女性患者的住院死亡率（OR 2.74；95%CI，2.48-3.02）和 30 天死亡率（OR 2.74；95%CI，2.48-3.02）更高。调整多个协变量后，性别差异减弱：住院死亡率（OR 1.19；95%CI，1.17-1.2），30 天死亡率（OR 1.18；95%CI，1.12-1.24）。OS 中，女性患者未经调整的长期死亡率高于男性（OR 1.41；95%CI，1.31-1.52），RCT 中，女性患者未经调整的长期死亡率高于男性（OR 1.4；95%CI，1.3-1.5）。

结论

ACS 女性患者的治疗延迟时间比男性更常见。她们也不太可能接受有创治疗。与男性相比，女性患者的短期和长期全因死亡率更差。然而，在调整多个协变量后，观察到的性别差异较小。考虑到死亡率的差异，我们认为有必要进一步研究特定危险因素对 ACS 结局的性别相关影响。

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