急性冠状动脉综合征患者使用冠状动脉介入治疗的性别差异:来自澳大利亚墨尔本一家大型城市医院的经验

Gender difference in the use of coronary interventions for patients with acute coronary syndrome: experience from a major metropolitan hospital in Melbourne, Australia

目的 :本研究旨在验证急性冠状动脉综合征(ACS)患者使用冠状动脉介入治疗的性别差异。方法 :对墨尔本一家大型城市医院2009-2012年住院的2096例ACS患者数据库进行了回顾性分析。ACS包括不稳定型心绞痛(UA)、ST段抬高型心肌梗死(STEMI)和非ST段抬高型心肌梗死(NSTEMI)。结果 :患者的平均年龄为64.3岁,其中624例(30%)为女性。一半病例被诊断为NSTEMI,23%的病例为STEMI,25%的病例为UA。与男性患者相比,女性患者入院时年龄较大,诊断为STEMI的比例较低,吸烟率较低;在严重共存病或使用冠状动脉造影方面,未观察到性别差异。诊断为STEMI的病例中,女性患者接受血管成形术支架的比例比男性患者低39%(调整OR=0.61,95%可信区间为0.39~0.96);接受冠状动脉旁路移植术的比例比男性患者低66%(调整OR=0.34,95%可信区间为0.13~0.93)。诊断为NSTEMI的病例中,女性患者接受冠状动脉旁路移植术的比例比男性患者低44%(调整OR=0.56,95%可信区间为0.37~0.83)。35~49岁的年轻病例中,女性患者接受血管成形术支架的比例低于男性患者;50岁以上的年长病例中,女性患者接受冠状动脉旁路移植术的比例低于男性患者。结论 :坚持以指南为基础的治疗,将有助于确保知识从指南到临床实践的转换。在进一步的研究中,调查临床表现,根据性别对ACS进行无创性检查和医学干预,也许可以更深入地解释冠状动脉介入治疗的性别差异。

Objective： The study aimed to examine gender differences in the use of coronary interventions amongst patients with acute coronary syndrome （ACS） admitted to a major metropolitan hospital in Melbourne during the period 2009-2012. Methods： We undertook a retrospective analysis of a hospital database of 2096 ACS patients. ACS included unstable angina （UA）, ST-segment-elevation myocardial infarction （STEMI） and non-STEMI （NSTEMI）. Results： The mean age of the patients was 64.3 years and 624 （30%） were women. Half of them were diagnosed as NSTEMI, 23% as STEMI and 25% as UA. Compared to men, women were older at admission, less likely to be diagnosed with STEMI and less likely to smoke. No gender difference was observed for severe co-morbidities or use of coronary angiography. Women diagnosed with STEMI were 39% less likely to receive an angioplasty stent （adjusted odds ratio 0.61, 95% confidence intervals 0.39-0.96） and 66% less likely to receive grafts （adjusted OR 0.34, 95% CIs 0.13-0.93）. Women diagnosed with NSTEMI were 44% less likely to receive grafts （adjusted OR 0.56, 95% CIs 0.37-0.83）. Younger women aged 35-49 years were less likely to receive an angioplasty stent, and older women 〉50 years were less likely to receive grafts. Conclusion： Adherence to guideline based treatment will help to ensure knowledge translation from guideline to practice. Further research investigating symptom presentation, use of non-invasive tests and medical management of ACS by gender may further explain gender difference for coronary interventions.