Behar S, Gottlieb S, Hod H, Narinsky R, Benari B, Rechavia E, Pauzner H, Rougin N, Kracoff O H, Katz A
Neufeld Cardiac Research Institute, Sheba Medical Center, Tel Hashomer, Israel.
Am J Cardiol. 1994 Mar 1;73(7):438-43. doi: 10.1016/0002-9149(94)90672-6.
A national study was performed in early 1992 in the 25 operating coronary care units in Israel, which enabled the assessment of whether the therapeutic management of patients with acute myocardial infarction was affected by patient gender. During a 2-month period, 1,014 consecutive patients with acute myocardial infarction were hospitalized. Thrombolytic therapy was given to 47% of men (362 of 769), and 43% of women (106 of 245) (p = NS). After adjustment for age, no gender differences in the administration of thrombolytic therapy were noted (odds ratio 0.95; 95% confidence interval 0.73-1.23). Coronary angiography was more frequently performed in men (22%) than in women (16%) (p < 0.05). However, no gender differences in the use of angioplasty or coronary bypass surgery performed during the index hospitalization were found (10% in men, and 8% in women). The main reasons for ineligibility for thrombolytic therapy were: late hospital arrival, absence of qualifying ST-T changes on admission electrocardiogram, and contraindications to thrombolytic therapy. Hospital death was significantly lower in patients receiving thrombolytic therapy (37 of 456; 8%) than in those excluded from thrombolysis (70 of 540;13%) (p < 0.01). This difference was significant for men, but not for women. The 1-year postdischarge mortality was 4% in patients treated compared with 12% in those ineligible for thrombolysis (p < 0.01). This significant difference persisted among men and women.
1992年初，以色列25个冠心病监护病房开展了一项全国性研究，该研究能够评估急性心肌梗死患者的治疗管理是否受患者性别的影响。在为期2个月的时间里，1014例急性心肌梗死患者连续入院。47%的男性（769例中的362例）和43%的女性（245例中的106例）接受了溶栓治疗（p =无显著性差异）。在对年龄进行调整后，未发现溶栓治疗的性别差异（优势比0.95；95%置信区间0.73 - 1.23）。男性接受冠状动脉造影的比例（22%）高于女性（16%）（p < 0.05）。然而，在本次住院期间进行血管成形术或冠状动脉搭桥手术的使用方面未发现性别差异（男性为10%，女性为8%）。不符合溶栓治疗条件的主要原因是：入院时间晚、入院心电图无符合条件的ST - T改变以及存在溶栓治疗的禁忌症。接受溶栓治疗的患者医院死亡率（456例中的37例；8%）显著低于未接受溶栓治疗的患者（540例中的70例；13%）（p < 0.01）。这种差异在男性中显著，但在女性中不显著。接受治疗的患者出院后1年死亡率为4%，而不符合溶栓条件的患者为12%（p < 0.01）。这种显著差异在男性和女性中均持续存在。
