Demirovic J, Blackburn H, McGovern P G, Luepker R, Sprafka J M, Gilbertson D
Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis 55454-1015, USA.
Am J Cardiol. 1995 Jun 1;75(16):1096-101. doi: 10.1016/s0002-9149(99)80737-1.
Although numerous studies indicate that women have a higher early mortality from acute myocardial infarction (AMI) than men, reasons for the difference are largely unexplained. We studied the role of sex in the prognosis of 1,600 patients with AMI aged 30 to 74 years in the population-based Minnesota Heart Survey. A 50% random sample was taken of all AMI patients hospitalized in 1980 and 1985 in the Twin Cities of Minnesota (Minneapolis-St. Paul) (1,168 men, 432 women). A multiple logistic regression model was used for predicting early death (within 28 days) and included baseline characteristics: sex, age, chest pain on admission, history of previous AMI, angina pectoris, coronary artery bypass surgery or hypertension, presence of heart failure, cardiac arrhythmias requiring direct-current shock, diabetes mellitus, valvular disease, cardiomyopathy, and levels of serum enzymes and blood urea nitrogen. Age-adjusted early mortality rate was significantly higher in women than men, but only in those aged < 65 years (12.5% of women vs 6.5% of men, p < 0.01) versus those aged > or = 65 years (19.5% vs 21.6%, p > 0.05). Multivariate analysis also showed that among those < 65 years, female sex was a strong and independent predictor of early death (odds ratio 2.0, 95% confidence interval 1.2 to 3.5, p < 0.01). Rates of coronary angiography, coronary artery bypass surgery, percutaneous transluminal coronary angioplasty, and thrombolysis performed during hospital stay were higher in men, but after adjustment for age, congestive heart failure, and diabetes mellitus, a statistically significant difference persisted only in the frequency of coronary angiography (26% in men vs 17% in women, p < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
尽管大量研究表明，女性急性心肌梗死（AMI）的早期死亡率高于男性，但造成这种差异的原因很大程度上尚不清楚。我们在基于人群的明尼苏达心脏调查中，研究了性别在1600例年龄在30至74岁的AMI患者预后中的作用。对1980年和1985年在明尼苏达州双子城（明尼阿波利斯 - 圣保罗）住院的所有AMI患者进行了50%的随机抽样（1168名男性，432名女性）。采用多元逻辑回归模型预测早期死亡（28天内），模型纳入的基线特征包括：性别、年龄、入院时胸痛情况、既往AMI病史、心绞痛、冠状动脉搭桥手术或高血压、心力衰竭、需要直流电除颤的心律失常、糖尿病、瓣膜病、心肌病以及血清酶和血尿素氮水平。年龄调整后的早期死亡率在女性中显著高于男性，但仅在年龄<65岁的人群中如此（女性为12.5%，男性为6.5%，p<0.01），而在年龄≥65岁的人群中并非如此（19.5%对21.6%，p>0.05）。多变量分析还显示，在年龄<65岁的人群中，女性是早期死亡的一个强有力且独立的预测因素（比值比2.0，95%置信区间1.2至3.5，p<0.01）。住院期间进行冠状动脉造影、冠状动脉搭桥手术、经皮腔内冠状动脉成形术和溶栓治疗的比例在男性中更高，但在调整年龄、充血性心力衰竭和糖尿病后，仅冠状动脉造影的频率存在统计学显著差异（男性为26%，女性为17%，p<0.05）。（摘要截断于250字）
