Sári Csaba, Heesch Christian M, Kovács Attila János, Andréka Péter
Gottsegen György National Cardiovascular Center, Budapest, Hungary.
Doctoral College of Semmelweis University, Semmelweis University, Budapest, Hungary.
Prev Med Rep. 2025 Jun 7;55:103131. doi: 10.1016/j.pmedr.2025.103131. eCollection 2025 Jul.
This study investigates differences based on sex in prognosis for acute coronary syndrome using data of 76,153 patients in Hungary's National Myocardial Infarction Register, focusing on all-cause mortality, risk factors, and treatment outcomes.
The data set analyzed is the result of mandatory reporting on patients presenting with acute coronary syndrome to hospitals in Hungary. The current study comprises a retrospective analysis of all cases reported to the registry from 2014 to 2019. The primary outcome measured was all-cause mortality, with an average follow-up of 3.6 years.
The patient cohort had a median age of 67.4 years; females were on average seven years older. Women had a less favorable cardiovascular risk profile, obtained less optimal treatment, experienced more complications, and were less likely to receive guideline-consistent therapy. An age-adjusted analysis demonstrated that age significantly influences risk profiles, types of acute coronary syndrome, treatment strategies, and outcomes. The unadjusted mortality rate for females was significantly higher; however, multivariable analysis indicated that a worse short-term prognosis was contrasted by a better long-term prognosis when comparing females to males.
This study highlights the need to further understand and address sex differences in the presentation and management of acute coronary syndrome. The noted higher mortality rates in female patients reveal the necessity for tailored, age-adjusted treatment strategies. Women often present with more advanced cardiovascular risk profiles and face barriers to timely care, making equitable access essential. Understanding the interplay between age, sex, and comorbidities is key to improving patient outcomes.
本研究利用匈牙利国家心肌梗死登记处76153例患者的数据，调查急性冠状动脉综合征预后的性别差异，重点关注全因死亡率、危险因素和治疗结果。
所分析的数据集是匈牙利医院对急性冠状动脉综合征患者进行强制报告的结果。本研究对2014年至2019年登记处报告的所有病例进行回顾性分析。测量的主要结局是全因死亡率，平均随访3.6年。
患者队列的中位年龄为67.4岁；女性平均年龄大7岁。女性的心血管风险状况较差，获得的治疗不够理想，经历的并发症更多，接受指南一致治疗的可能性更小。年龄调整分析表明，年龄显著影响风险状况、急性冠状动脉综合征类型、治疗策略和结果。女性的未调整死亡率显著更高；然而，多变量分析表明，与男性相比，女性短期预后较差，但长期预后较好。
本研究强调需要进一步了解和解决急性冠状动脉综合征的表现和管理中的性别差异。女性患者较高的死亡率表明需要制定针对性的、年龄调整的治疗策略。女性通常具有更严重的心血管风险状况，且在及时就医方面面临障碍，因此公平就医至关重要。了解年龄、性别和合并症之间的相互作用是改善患者预后的关键。
