在急性冠状动脉综合征后死亡率的性别差异
Jeffrey S Berger1, Laine Elliott, Dianne Gallup
1Department of Medicine, New York University School of Medicine, 530 First Ave, Skirball 9R, New York, NY 10016, USA. jeffrey.berger@nyumc.org
JAMA
|August 27, 2009
概括
急性冠状动脉综合征 (ACS) 后短期死亡率的性别差异是由临床表现和疾病严重程度解释的. 调整后的分析显示30天死亡率没有显著的性别差异,在ACS类型中观察到的差异.
科学领域:
- 心脏病学 心脏病学
- 临床研究 临床研究
- 健康中的性别差异
背景情况:
- 关于急性冠状动脉综合征 (ACS) 后短期死亡率的性别差异存在相互矛盾的数据.
- 了解这些差异对于有效的患者管理和风险分层至关重要.
研究的目的:
- 在ACS.中调查性别和30天死亡率之间的关系.
- 为了确定临床综合症或冠状动脉解剖学是否改变了这种关系.
- 在大型ACS患者数据库中调整潜在的混临床共变量.
主要方法:
- 从11个国际随机的ACS临床试验 (1993-2006) 的数据汇总.
- 包括136,247名患者:38,048名女性 (28%).
- 根据ST段升高心肌梗塞 (STEMI),非STEMI (NSTEMI) 和不稳定的心痛进行子组分析.
主要成果:
- 没有调整的30天死亡率在女性 (9.6%) 和男性 (5.3%) 中较高.
- 在多变量调整后,没有观察到死亡率的显著性别差异 (调整的OR,1.06).
- 根据ACS类型的显著相互作用:STEMI患者的女性死亡率更高,NSTEMI患者的女性死亡率更低,以及不稳定的胸痛. 经过对血管学疾病严重程度进行调整后,差异减弱.
结论:
- 30天 ACS 死亡率存在基于性别的差异,但取决于临床表现.
- 这些差异在很大程度上是由临床因素在呈现和血管学记录的疾病严重程度的差异解释的.
- 考虑到这些因素后,性别不是ACS.30天死亡率的独立预测因素.
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