Huber Elodie, Le Pogam Marie-Annick, Clair Carole
Department of Ambulatory Care, Center for Primary Care and Public Health, Lausanne, Vaud, Switzerland.
Department of Epidemiology and Health Systems, Center for Primary Care and Public Health, Lausanne, Vaud, Switzerland.
BMJ Med. 2022 Nov 17;1(1):e000300. doi: 10.1136/bmjmed-2022-000300. eCollection 2022.
To assess the differences in the management and prognosis of acute coronary syndrome in men and women who were admitted to hospital for acute coronary syndrome.
Cross sectional study.
Discharge data from Swiss hospitals linked at the hospital and patient levels.
224 249 adults (18 years and older) were admitted to hospital for acute coronary syndrome between 1 January 2009 and 31 December 2017 in any Swiss hospital, of which 72 947 (32.5%) were women. People who were discharged against medical advice were excluded.
Women admitted to hospital with acute coronary syndrome were older than their male counterparts (mean age 74.9 years (standard deviation 12.4) 67.0 years (13.2)). Irrespective of acute coronary syndrome type, women were less likely to undergo diagnostic procedures, such as coronary angiography (adjusted odds ratio 0.79 (95% confidence interval 0.77 to 0.82) for non-ST-segment elevation myocardial infarction 0.87 (0.84 to 0.91) for ST-segment elevation myocardial infarction)) and ventriculography (0.84 (0.82 to 0.87) 0.90 (0.87 to 0.91)). Women were also less likely to receive treatments, such as percutaneous coronary intervention (0.67 (0.65 to 0.69) 0.76 (0.73 to 0.78)) and coronary artery bypass graft (0.57 (0.53 to 0.61) 0.79 (0.72 to 0.87)). Women had a poorer prognosis than men, with a higher likelihood of healthcare related complications (1.10 (1.06 to 1.15) 1.14 (1.09 to 1.21)) and of a longer hospital stay (1.24 (1.20 to 1.27) 1.24 (1.20 to 1.29)). In non-adjusted models, the likelihood of death in hospital was higher among women (odds ratio 1.30 (95% confidence interval 1.24 to 1.37) for non-ST-segment elevation myocardial infarction 1.75 (1.66 to 1.85) for ST-segment elevation myocardial infarction), but the association was reversed for ST-segment elevation myocardial infarction (adjusted odds ratio 0.87 (0.82 to 0.92)) or was non-significant for non-ST-segment elevation myocardial infarction (1.00 (0.94 to 1.06)) after adjustment for confounding variables. The main effect modifier was age: younger women were more likely to die than men of the same age and older women were less likely to die than men of the same age. For example, women who were younger than 50 years had a 38% increased likelihood of dying compared with men of the same age range (adjusted odds ratio 1.38 (1.04 to 1.83)).
Sex inequalities were reported in the management of heart disease in this population of patients from a high income country with good healthcare coverage. These differences affect mortality and morbidity, especially in younger women. Efforts are needed to overcome these inequalities, including educational programmes aimed at healthcare professionals.
评估因急性冠脉综合征入院的男性和女性在急性冠脉综合征管理及预后方面的差异。
横断面研究。
来自瑞士医院的出院数据，在医院和患者层面进行关联。
2009年1月1日至2017年12月31日期间，瑞士任何一家医院收治的224249名成年人（18岁及以上）因急性冠脉综合征入院，其中72947名（32.5%）为女性。拒绝医嘱出院的患者被排除。
因急性冠脉综合征入院的女性比男性年龄更大（平均年龄74.9岁（标准差12.4）对67.0岁（13.2））。无论急性冠脉综合征类型如何，女性接受诊断性检查的可能性较低，如冠状动脉造影（非ST段抬高型心肌梗死的调整优势比为0.79（95%置信区间0.77至0.82），ST段抬高型心肌梗死为0.87（0.84至0.91））和心室造影（0.84（0.82至0.87）对0.90（0.87至0.91））。女性接受治疗的可能性也较低，如经皮冠状动脉介入治疗（0.67（0.65至0.69）对0.76（0.73至0.78））和冠状动脉旁路移植术（0.57（0.53至0.61）对0.79（0.72至0.87））。女性的预后比男性差，发生医疗相关并发症的可能性更高（1.10（1.06至1.15）对1.14（1.09至1.21）），住院时间更长（1.24（1.20至1.27）对1.24（1.20至1.29））。在未调整的模型中，女性住院死亡的可能性更高（非ST段抬高型心肌梗死的优势比为1.30（95%置信区间1.24至1.37），ST段抬高型心肌梗死为1.75（1.66至1.85）），但在调整混杂变量后，ST段抬高型心肌梗死的关联发生逆转（调整优势比为0.87（0.82至0.92）），非ST段抬高型心肌梗死则无显著关联（1.00（0.94至1.06））。主要效应修饰因素是年龄：年轻女性比同年龄男性死亡可能性更高，老年女性比同年龄男性死亡可能性更低。例如，50岁以下的女性与同年龄范围的男性相比，死亡可能性增加38%（调整优势比为1.38（1.04至1.83））。
在这个医疗覆盖良好的高收入国家的患者群体中，心脏病管理方面存在性别不平等。这些差异影响死亡率和发病率，尤其是在年轻女性中。需要努力克服这些不平等，包括针对医疗专业人员的教育项目。
