Maynard C, Every N R, Martin J S, Kudenchuk P J, Weaver W D
Department of Medicine, University of Washington, Seattle, USA.
Arch Intern Med. 1997 Jun 23;157(12):1379-84.
During the last 5 years, many studies have produced conflicting results concerning the survival of women hospitalized with acute myocardial infarction (AMI).
To determine if gender is associated with hospital mortality and long-term survival in individuals with AMI.
This prospective study included 4255 consecutive women (34%) and 8076 (66%) men who developed AMI in 19 Seattle, Wash, area hospitals between January 1988 and June 1994. Key information was abstracted from hospital records and entered in the Myocardial Infarction Triage and Intervention registry database. In addition, data concerning survival and rehospitalization were obtained from the state of Washington and linked to the Myocardial Infarction Triage and Intervention registry.
In comparison with men, women were 8 years older, more often had history of congestive heart failure, hypertension, or diabetes mellitus, and less often had history of myocardial infarction or coronary surgery. During hospitalization, women were less likely to undergo coronary angiography, thrombolytic therapy, coronary angioplasty, or bypass surgery. After adjustment for covariates, women were 20% more likely to die in the hospital (odds ratio, 1.22; 95% confidence interval, 1.06-1.39), yet long-term survival was similar in the 2 groups (hazard ratio, 0.97; 95% confidence interval, 0.90-1.05). The use of thrombolytic therapy or revascularization during the index hospitalization did not change the association between gender and survival.
All things being equal, women with AMI were more likely to die in the hospital, yet survival after hospital discharge did not differ according to gender. Appropriate treatment to reduce hospital mortality in women is needed.
在过去5年中，许多研究就急性心肌梗死（AMI）住院女性的生存率得出了相互矛盾的结果。
确定性别是否与AMI患者的医院死亡率和长期生存率相关。
这项前瞻性研究纳入了1988年1月至1994年6月期间在华盛顿州西雅图地区19家医院发生AMI的4255名连续女性患者（34%）和8076名男性患者（66%）。关键信息从医院记录中提取并录入心肌梗死分诊与干预登记数据库。此外，有关生存和再次住院的数据从华盛顿州获取并与心肌梗死分诊与干预登记相链接。
与男性相比，女性年龄大8岁，更常患有充血性心力衰竭、高血压或糖尿病史，而较少有心肌梗死或冠状动脉手术史。住院期间，女性接受冠状动脉造影、溶栓治疗、冠状动脉成形术或搭桥手术的可能性较小。在对协变量进行调整后，女性在医院死亡的可能性高20%（优势比，1.22；95%置信区间，1.06 - 1.39），然而两组的长期生存率相似（风险比，0.97；95%置信区间，0.90 - 1.05）。在首次住院期间使用溶栓治疗或血运重建并未改变性别与生存之间的关联。
在其他条件相同的情况下，AMI女性在医院死亡的可能性更大，但出院后的生存率并无性别差异。需要采取适当治疗以降低女性的医院死亡率。
