Hochman J S, McCabe C H, Stone P H, Becker R C, Cannon C P, DeFeo-Fraulini T, Thompson B, Steingart R, Knatterud G, Braunwald E
Department of Medicine, St. Luke's/Roosevelt Hospital Center and Columbia University, New York, New York 10025, USA.
J Am Coll Cardiol. 1997 Jul;30(1):141-8. doi: 10.1016/s0735-1097(97)00107-1.
Women and men enrolled in the Thrombolysis in Myocardial Infarction (TIMI) IIIB trial of unstable angina and non-Q wave myocardial infarction (MI) were evaluated to determine gender differences in characteristics and outcome.
Coronary heart disease is the leading cause of death for women and men. However, the characteristics and outcome of women compared with men with unstable angina and non-Q wave MI have not been extensively studied.
The characteristics, outcomes and proportion of 497 women and 976 men with unstable angina and non-Q wave MI at the time of enrollment were compared. When these proportions were noted to be significantly different, we compared them with the 7,731-patient TIMI IIIB Registry, which represents the non-trial, screened population with these syndromes at these centers.
For both coronary syndromes, women were older, were less frequently white, had a higher incidence of diabetes and hypertension and were receiving more cardiac medications. The 42-day rate of death and MI in TIMI IIIB was similar for women and men (7.4% vs. 7.5%). Coronary angiography revealed less severe coronary artery disease for women than for men, with absence of critical obstructions in 25% versus 16% and mean ejection fractions 62 +/- 12% versus 57 +/- 13% for women versus men (p < 0.01). Medical management failed in women as often as in men, and rates of cardiac catheterization and percutaneous transluminal coronary angioplasty or coronary artery bypass graft surgery were similar for women and men in the conservative strategy arm as well as in the invasive strategy arm. Women in the TIMI IIIB trial had proportionately more unstable angina than did men. The proportion of unstable angina and non-Q wave MI for women was similar in the trial and Registry. However, proportionately more men in the trial had non-Q wave MI than men in the Registry.
对参加心肌梗死溶栓治疗（TIMI）IIIB试验的不稳定型心绞痛和非Q波心肌梗死（MI）的女性和男性进行评估，以确定其特征和预后方面的性别差异。
冠心病是女性和男性的主要死因。然而，与患有不稳定型心绞痛和非Q波MI的男性相比，女性的特征和预后尚未得到广泛研究。
比较了497名女性和976名男性在入组时不稳定型心绞痛和非Q波MI的特征、预后及比例。当发现这些比例有显著差异时，我们将其与包含7731名患者的TIMI IIIB注册登记数据进行比较，该数据代表了这些中心患有这些综合征的未参与试验的筛查人群。
对于这两种冠状动脉综合征，女性年龄更大，白人比例更低，糖尿病和高血压发病率更高，且正在服用更多的心脏药物。TIMI IIIB试验中女性和男性42天的死亡和MI发生率相似（7.4%对7.5%）。冠状动脉造影显示，女性的冠状动脉疾病比男性轻，25%的女性无严重阻塞，而男性为16%，女性的平均射血分数为62±12%，男性为57±13%（p<0.01）。女性和男性的药物治疗失败率相同，在保守治疗组以及侵入性治疗组中，女性和男性的心导管检查、经皮腔内冠状动脉成形术或冠状动脉旁路移植手术的发生率相似。TIMI IIIB试验中的女性不稳定型心绞痛比例比男性高。试验中女性不稳定型心绞痛和非Q波MI的比例与注册登记数据中的相似。然而，试验中患有非Q波MI的男性比例比注册登记数据中的男性高。
1）每种急性冠状动脉综合征的女性患者比男性年龄更大，合并症更多。2）不稳定型心绞痛和非Q波MI的预后与疾病严重程度有关，而非性别。3）不稳定型心绞痛和非Q波MI的血运重建相关死亡率在女性和男性中相似。4）每种急性冠状动脉综合征的入组女性和男性比例不同。这些比例既反映了疾病的患病率，也反映了由于试验纳入标准和其他已确定因素导致的选择偏倚。
