Vaccarino V, Krumholz H M, Mendes de Leon C F, Holford T R, Seeman T E, Horwitz R I, Berkman L F
Department of Epidemiology and Public Health, Yale University School of Medicine, New Haven, Connecticut 06520-8034, USA.
J Am Geriatr Soc. 1996 Oct;44(10):1174-82. doi: 10.1111/j.1532-5415.1996.tb01366.x.
To determine sex differences in survival after myocardial infarction in older individuals.
Prospective cohort study based on a community sample of older individuals. All patients were followed for 1 year after hospital admission.
Two hospitals in New Haven, Connecticut.
The study included 103 women and 120 men who were participants in the New Haven, CT cohort of the Established Populations for the Epidemiologic Study of the Elderly (EPESE) program and who were diagnosed with myocardial infarction between the inception of the community study in 1982 and December 31, 1992. The mean age of women was 79.3 and of men, 77.3.
Data on clinical characteristics were abstracted from medical records. Sociodemographic, psychosocial, and physical function information was derived from the EPESE interview preceding the infarction. The main outcome measure was all-cause mortality, for which three end points were used: early mortality (first 30 days), late mortality (1-year mortality among survivors of the first 30 days), and overall mortality (1-year mortality from admission in the whole sample).
Mortality in the first 30 days did not differ significantly in the two sexes. The relative risk (RR) of death in women compared with men was 0.85 (95% confidence interval [CI], 0.49-1.47) before multivariable adjustment; this was unchanged after adjustment for demographic factors, comorbidity, functional status, psychosocial factors, and clinical severity (RR, 0.85, 95% CI, 0.41-1.76). Among survivors of 30 days, women were almost two times more likely to survive at 1 year compared with men, both before multivariable adjustment (RR, 0.56, 95% CI, 0.31-1.02) and after controlling for demographic factors, comorbidity, physical function, psychosocial factors, clinical severity on admission, and hospital complications (RR, 0.44 ; 95% CI, 0.20-0.99). Analyses involving 1-year follow-up from admission for the entire sample yielded intermediate results.
There was little difference in mortality in the first 30 days after myocardial infarction between older men and women, but when the early deaths were excluded, women showed an increased survival compared with men in the first year after the myocardial infarction.
确定老年人心肌梗死后生存情况的性别差异。
基于老年人群社区样本的前瞻性队列研究。所有患者在入院后随访1年。
康涅狄格州纽黑文的两家医院。
该研究纳入了103名女性和120名男性，他们是康涅狄格州纽黑文老年人流行病学研究既定人群队列研究（EPESE）项目的参与者，并且在1982年社区研究开始至1992年12月31日期间被诊断为心肌梗死。女性的平均年龄为79.3岁，男性为77.3岁。
临床特征数据从医疗记录中提取。社会人口统计学、心理社会和身体功能信息来自心肌梗死前的EPESE访谈。主要结局指标是全因死亡率，为此使用了三个终点：早期死亡率（前30天）、晚期死亡率（前30天幸存者中的1年死亡率）和总体死亡率（整个样本入院后1年死亡率）。
前30天的死亡率在两性之间无显著差异。多变量调整前，女性与男性相比的死亡相对风险（RR）为0.85（95%置信区间[CI]，0.49 - 1.47）；在调整人口统计学因素、合并症、功能状态、心理社会因素和临床严重程度后，这一结果未变（RR，0.85，95% CI，0.41 - 1.76）。在30天幸存者中，无论多变量调整前（RR，0.56，95% CI，0.31 - 1.02）还是在控制人口统计学因素、合并症、身体功能、心理社会因素、入院时临床严重程度和医院并发症后，女性1年生存率几乎是男性的两倍（RR，0.44；95% CI，0.20 - 0.99）。对整个样本入院后1年随访的分析得出了中间结果。
老年男性和女性心肌梗死后前30天的死亡率差异不大，但排除早期死亡后，女性在心肌梗死后第一年的生存率高于男性。
